Fill our the data form provided. Answer all or any pertinent questions.
Make blank copies of this form to keep information current or please download a form and update the information.
Place the decal on front of a plastic baggie
Place the form you filled out in the plastic baggie
You may also consider placing the following items in the baggie as will
Copy of EKG
DNR(Do Not Resuscitate)
Living will or equivalent
Recent picture of self
Place the baggie on your refrigerator door
Securely tape plastic baggie to front of refrigerator door.
Place the decal on the side of your refrigerator or on the front door where anyone responding to an emergency could easily see it.
Place the second decal on your front door
Place the decal on the front door so it can easily be seen by anyone emergency.
Get your Life Data form (PDF) today and become a part of this program by contacting Tanya at EMS, Phone: 281-554-1201 or visit an EMS station 1, Monday - Thursday 8 a.m. to 5 p.m. and Friday 8 a.m. to 11 a.m.