Get Fl Doh Personal Survey Form

The Florida Department of Health's Personal Survey Form is designed to assist individuals with special needs in preparing for emergencies. This guide will provide you with clear, step-by-step instructions for completing the form online, ensuring that first responders have the necessary information to provide assistance during disasters.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the online version of the FL DoH Personal Survey Form.
2. Begin by filling in your personal information. Provide your first name, middle initial, last name, and any suffix. Make sure to enter your email address accurately as it will be used to send annual reminders for updates.
3. You will need to provide your physical address, including the street address, apartment number (if applicable), city, state, zip code, county, and municipality. If your mailing address differs from your physical address, include that information as well.
4. Next, enter your primary and secondary phone numbers. Indicate if your primary phone is a TTY/TTD device and if you do not have a phone.
5. Complete the section on your date of birth, height, weight, and gender. This information is important for emergency responders.
6. Provide emergency contact information for a trusted individual, including their name, address, relationship to you, and phone numbers. Optionally, include a secondary contact.
7. Fill out any additional contact information, such as physicians, home health care providers, pharmacies, and any medical equipment providers.
8. In the evacuation information section, check applicable boxes regarding any specific needs, disabilities, or conditions that may affect your evacuation status. Be thorough and specific about your transportation needs and limitations.
9. Indicate the required assistance levels, including whether you have temporary or permanent conditions, and if you need evacuation assistance around the clock.
10. Complete the service animals/pets section if applicable, detailing any service animals that also require assistance during an evacuation.
11. Finally, provide any additional comments or information that may assist emergency personnel. Review all filled fields for accuracy and completeness.
12. After finishing the form, you can save your changes, download a copy, print the form, or share it as necessary.

Complete your FL DoH Personal Survey Form online today for enhanced emergency planning.