Our Marcus Alert Database gives individuals with a behavioral health illness, mental health illness, developmental or intellectual disability, or brain injury the opportunity to provide emergency response agencies with information regarding their special needs.

Parents of individuals under the age of 18 and legal guardians may also share this information with us. In the event of an emergency, first responders will be better equipped to serve them.

The information collected here will not be available to the public. It will only be shared with emergency response agencies to improve their ability to serve. By submitting your information, you agree that you voluntarily authorize its release to emergency responders.

Submitter's Information

Phone Number

Submitter's Relationship to Subject

MARCUS Alert Subject Information

Home Phone Number

Cell Phone Number

TTY Number (If Applicable)

Gender

Male

Female

Information to be Provided to Emergency Services Personnel

Emergency Contact Information

Phone Number

Relationship to MARCUS Subject

By submitting this information, you agree to give local law enforcement personnel, Office of Emergency Management designees and responders permission to enter your home in the case of an emergency to assist in care and/or evacuation.

Your Unique Report ID, for recordkeeping:

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