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Welcome to the Miami Township, OH, Action Line
Today is Wednesday, May 24, 2017.
Special Needs Notification

Purpose. Do you have special medical needs that we should know about? In an effort to provide high quality care for patients with special needs, our Fire/EMS Department maintains a registry with detailed information specific to their needs. A special needs patient requiring EMS service may require specialized care related to equipment and medical history. An example of special needs are patients on home ventilators, patients with implanted defibrillator or any patient that relies on someone else for care and cannot care for themselves. If you have a family member or friend with special needs living in Miami Township, please complete the information below and we will call you. Due to the nature of the information we are requesting, we feel it important to speak to someone directly in order to obtain specific information regarding the person with a special medical need. Please allow a few days for us to contact you.

* Information is required.

Contact Information

* First Name:
* Last Name:
* Email:
* Daytime Phone: (
* Address:
* City:
* State:
* ZIP:

Anything special we should know about prior to calling you?
 
Check here to have email confirmation of this submission.

* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.

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