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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:
ballen@apdny.org and bpeters@apdny.org