Keeping an emergency contact list in a Go Bag is crucial because it allows you to quickly reach out to family, friends, or important medical professionals in the event of an emergency.
Provide the same information for each individual or family member when completing for more than one person.
When filling out your personal and emergency contact information, note the date this information was completed.
Important Information PDF form
Your Information
- Name
- Telephone number
- Email address
- Address
- Date of birth
- Blood type
First Emergency Contact
- Name
- Telephone number
- Email address
- Relationship
Second Emergency Contact
- Name
- Telephone number
- Email address
- Relationship
Doctor’s Information
- Primary care doctor
- Name
- Telephone number
- Fax number
- Address
- Other doctor
- Name
- Telephone number
- Fax number
- Address
Insurance Information
- Medical insurance
- Company name
- Telephone number
- Policy/account number
- Life insurance
- Company name
- Telephone number
- Policy/account number
- Homeowners/rental insurance
- Company name
- Telephone number
- Policy/account number
Personal Care Assistant Information
- Name
- Telephone number
- Email address
Service Animal Information
- Name
- Breed
- Vaccination dates
Veterinarian Information
- Name
- Telephone number
- Email address
Kennel Information
- Contact name
- Telephone number
- Email address
