Handle with Care Application

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Client Information
Please list any other Physical, Psychological, or Diagnosed Behavioral special needs which shall serve as a reminder to the first responders that needed special consideration or attention may be needed or given to the individual involved in a call for service. (Examples Autism, Dementia, Down Syndrome, Hearing Impaired, Immobility, Speech or language impaired, Etc.)

Emergency Contact Information

Contact 1

Contact 2


Vehicle Information

Vehicle 1

Vehicle 2

Vehicle 3

Please allow three business days for contact by Sheriff's Office personnel. All information received on this form will be kept private and not for public use. If you have any questions, please call the Sheriff's Office at 804-556-5349.
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