Request Assistance

Request Assistance to Connect With Us

Under Florida Law, e-mail addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

This information will only be used to ensure the most appropriate service during an emergency. Please fill out at least one form of contact info so that we can follow up with you.

First Name

Last Name

Email address

Phone Number

Select choices

I need assistance with signing up for CodeRed
I am an at-risk senior
I am a person with special needs

If applicable, please share your special needs below

e.g. in a wheelchair, hearing impaired, etc.