Public Health Registry Program

 

In the event of a disaster or other extraordinary situation, some individuals with special medical needs may require assistance. The Casper-Natrona County Health Department, in cooperation with Natrona County Emergency management, is working to identify those individuals through this voluntary registration program.

If you or a family member has a special medical need, complete the form below. All information will be kept confidential, shared only with emergency response agencies so that we may reach you or your loved one with assistance when necessary. Please complete only one form per person.

 Please provide us with your contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State
Zip/Postal Code
Country
Work Phone
Home Phone

 Please identify your medical need (check all the apply):

I am on supplemental oxygen.
I am an insulin-dependent Diabetic.
I use an electric wheelchair.
I use a manual wheelchair.
I use a walker.
I am on a ventilator continuously.
I am on kidney dialysis.
I am hearing impaired or deaf.
I am visually impaired or blind.

 I have other special medical needs:


                   

 

 

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City of Casper-Natrona County Health Department
475 S. Spruce St
Casper, WY 82601
Tel: (307) 235-9340
Fax: (307) 237-2036

Hours:
Mon.-Wed.-Fri.
8:00am - 5:00pm
Tues.-Thurs.
7:30am-6:30pm