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Emergency Services & Safety /  Emergency Response Data Form

Emergency Response Data Form

Everybody has needs. Do the right people know what yours are?

If you or someone in your household has a disability or a special medical need, when you call for help in an emergency the responders need to know. Whether it affects your entire community, your street, or just your home, seconds can make a life or death difference. That’s why we encourage you to take a minute to fill out the form below and return it to the Town of Amherst Office of Emergency Services & Safety

  • Click here for online submission form (preferred method).

If you prefer, select a printable form in PDF format or Text format.

Mail your completed form to: 
Emergency Services & Safety
4220 Bailey Ave
Amherst, NY 14226

or you may scan and email completed form to: and

About Amherst

The Town of Amherst was established in 1818 and celebrated its 200th Anniversary in 2018. The town has a geographical area of 53.6 square miles and a population of greater than 122,000.

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Americans with Disabilities Act (ADA)

The Town of Amherst ADA Coordinators are Robert McCarthy (Director of Human Resources) and Mark Berke (Commissioner of Buildings).

Click for more information about ADA.

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The Town of Amherst takes great pride in providing useful, timely and accurate information through its official website. We encourage public participation in our website and ask that you provide your feedback to help us make our site even better. Contact the website administrator at

Get in Touch

  • General Information:
    (716) 631-7000
  • Email:
  • Address:
    Municipal Building (Town Hall)
  • 5583 Main Street
  • Williamsville, NY 14221