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Special Medical Needs Registration

The City of Jacksonville Emergency Preparedness Division maintains a registry of clients who have been identified as persons with Special Medical Needs. These individuals require assistance during evacuations and sheltering.

Who is a Special Medical Needs Client?
A person qualifying for special medical needs is someone who is medically dependent on electricity (i.e. electricity needed for life-supporting equipment), oxygen, or individuals with physical, medical, cognitive impairment, or sensory disabilities who may require basic assistance from medical professionals. 

Registration Process

You may register online now through the City of Jacksonville's Special Medical Needs Registry.

You may also download a registration form and follow the instructions at the bottom of the form to submit by mail, fax, or electronically. 

Download the Special Medical Needs Registration Form:

Any person that meets the above criteria and plans to use a Special Medical Needs Shelter during an evacuation should register online by filling out the form below well in advance or by contacting the Emergency Preparedness Office by phone (904) 255-3172.
The registry is updated throughout the year. Each client must re-register every year to remain in the system.

Special medical needs clients will receive notification at the beginning of the calendar year informing them of the need to re-register.

Each individual's registration form is reviewed by a Health Care Professional and categorized by the assistance required.

Individuals will be notified by email or mail with information regarding their acceptance into the Special Medical Needs Registry and an overview of the program.

Tips For Filling Out Your Registration

  • Complete the entire registration form, making sure you provide as much information as possible.
  • If registering by mail, please write legibly using print or block style. No cursive.
  • Remember to list a contact number. We can't contact you in times of emergency if there isn't a number listed or if that number isn't accurate.
  • One form per individual.  (Note: If you and your spouse both need to register, please complete a form for each person.)
  • Don’t forget to add your apartment/unit number. A majority of our returned mail is because the apartment/unit number was not listed on the registration form.  We cannot accept P.O.  Box addresses.
  • Registration is required ANNUALLY. We will notify you when it is time to re-register by email, phone and mail.
  • Please don’t forget to inform us of the death of loved ones so we can remove them from the list.
  • What to expect at a special medical needs shelter: special medical needs shelter information

What happens during an evacuation?
Special Medical Needs clients residing in an evacuation zone intended to be evacuated will be contacted by a Department of Health representative from the Emergency Operations Center to confirm his/her intentions to evacuate and to determine any transportation needs.  Individuals requiring transportation will be contacted by phone to coordinate a pickup time. Please be ready when transportation arrives and make sure you have packed all essential items.

A caregivers or family member must accompany the Special Medical Needs registrant to the shelter.

Once the storm has passed, individuals are returned home by the same mode of transportation in which they arrived. Special Medical Needs program officials will verify that the individual's residence is safe and habitable prior to their return.

These forms require Adobe Acrobat Reader, available for free from Adobe. If you do not have Acrobat Reader, click Adobe for a free download.