Emergency Contact Form

Help your patients stay prepared and organized when an emergency occurs with our Emergency Contact Form. Download for free today!

By Audrey Liz Perez on Jun 03, 2024.

Fact Checked by Ericka Pingol.

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What is an emergency contact?

In emergencies where the victim needs immediate medical assistance, a primary emergency contact is valuable. Having this crucial information could save lives. In 2019, injuries worldwide led to 4.4 million deaths, making up 8% of all deaths. The Disease Control Priorities Project (2018) points out that providing better emergency care could significantly reduce deaths and disabilities in low and middle-income countries (World Health Organization, n.d.). 

An emergency contact is designated to be contacted in an emergency or crisis. This individual should be someone the individual trusts, knowledgeable about basic information, medical conditions, and preferences, and able to provide reliable support during difficult situations. Emergency contacts may be family members, friends, neighbors, or even coworkers, but the critical factor is their ability to respond quickly and effectively in times of need.

Printable Emergency Contact Form

Download this Emergency Contact Form and store all of your client’s emergency contact information.

What is an Emergency Contact Form?

An Emergency Contact Form is a vital document containing comprehensive information about these designated individuals, ensuring their details are readily accessible in a single, organized location. 

The form typically includes the following information:

  • Contact details: This consists of the emergency contact's full name, primary and secondary phone numbers, and email address. Providing multiple means of communication increases the chances of reaching your contact during an emergency. It is helpful to provide a secondary emergency contact person, too. 
  • Relationship: Specifying the connection to the emergency contact (e.g., spouse, parent, friend) helps responders understand the contact's relevance and potential role in decision-making or support.
  • Preferred contact method: Indicating the preferred method of communication (phone, text, email, or any other) ensures that the emergency contact can be reached most effectively and conveniently.
  • Type of emergencies: Listing the types of emergencies for which the contact should be notified (medical, fire, natural disaster, personal crisis, or other) helps streamline the communication process and involve the correct individuals in specific situations.
  • Addresses: Including your emergency contact's home and work addresses of the emergency contact allows responders or support personnel to locate them if needed, especially in situations where phone or email communication is not possible.

In short, the form serves as a reference point for emergency responders to quickly identify and contact the appropriate contacts when time is of the essence.

How does this printable Emergency Contact Form work?

Understanding the importance of being prepared for emergencies is crucial, and having a well-organized Emergency Contact Form can make all the difference in such situations. Our printable Emergency Contact Form template is designed to help your client compile and store essential information about their designated contacts in a clear and easily accessible format. Follow the steps below:

Step 1: Download the form

You can download the Emergency Contact Form from the link on this page. Depending on the number of emergency contacts they wish to designate, you may instruct your clients to print as many copies of the form as they need.

Step 3: Fill out the form

Provide the required information. It must be accurate and up-to-date information for emergency contacts, including their name, relationships, phone numbers, email addresses, home and work addresses, preferred contact methods, and the types of emergencies they should be contacted for.

Step 4: Share the form

Instruct them to share the form with their emergency contacts. Ensure their designated contacts know their role and provide them with a copy of the filled-out form for their reference.

Step 5: Store for future use

Store the completed form in a safe and accessible location. Keep the form where it can be easily found during a medical emergency, such as in a folder or binder with other necessary documents.

Emergency Contact Form example (sample)

To assist you in helping your clients fill out the Emergency Contact Form, we have prepared a downloadable filled-out sample form. This example is a valuable reference, demonstrating how to provide accurate and detailed information for emergency contacts. By examining this sample, you can better understand the specific information required and the appropriate way to present it in the form.

Download this Emergency Contact Form example (sample) here:

Emergency Contact Form example (sample)

When to use the Emergency Contact Form?

An Emergency Contact Form should be used in various situations where having a readily accessible and organized document containing your designated contacts' information is vital. These situations include:

  • Managing medical emergencies: Ensure quick notification of designated contacts and informed decision-making by healthcare professionals regarding patients with known medical conditions or allergies.
  • Traveling: Facilitate assistance in case of accidents or lost documents while traveling, particularly in unfamiliar locations or abroad. This offers peace of mind for both patients and their companions.
  • Caring for children and aging relatives: Provide essential information to caretakers or school officials for prompt communication with designated contacts during emergencies involving children or aging family members.
  • Responding to natural disasters or large-scale emergencies: Enable emergency responders or relief organizations to swiftly reach designated contacts for coordination and support during earthquakes, floods, or hurricanes.
  • Addressing personal crises: Support friends, family members, or support professionals in offering assistance and guidance during personal crises, such as mental health emergencies, financial hardships, or legal troubles, through readily available contact information.

In all these situations, the Emergency Contact Form templates ensure that your patient's vital contact information is well-organized, easy to access, and available. Using these templates, they can effectively prepare for emergencies and maintain clear lines of communication with designated contacts.

Why use Carepatron as your patient record software?

Carepatron stands out as the ideal platform for managing emergency contact information. Our intuitive design allows users to easily navigate the platform and manage their Emergency Contact Forms without hassle. The simple layout ensures that even those with limited technical skills can confidently use our free patient record software.

We also offer a variety of customizable templates, allowing users to tailor the Emergency Contact Forms to their specific needs. With Carepatron, your clients can access your emergency contact forms from any device with internet connectivity. This feature is crucial during emergencies when contact information needs to be retrieved quickly. Emergency contact details stored in a secured platform ensure you can access them anytime, anywhere.

Carepatron readily shares Emergency Contact Forms with family members, friends, or caregivers. Clients can access emergency contact information when needed through the patient portal.

By choosing Carepatron, you can trust that your essential information is well-managed and readily available when needed. Sign up today for free!

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World Health Organization. (n.d.). Emergency care saves lives. https://www.who.int/initiatives/emergency-care-saves-lives

How to use the Emergency Contact Form?
How to use the Emergency Contact Form?

Commonly asked questions

How to use the Emergency Contact Form?

To use the Emergency Contact Form, download and print the template, fill in the required information for each emergency contact, and store the completed form in a safe and easily accessible location. Be sure to provide a copy to your designated contacts so they know their role and have the necessary information.

How should the Emergency Contact Form be stored?

The Emergency Contact Form should be stored in an easily accessible and secure location. Consider keeping the form in a folder or binder with other necessary documents, such as insurance policies and medical records. It is also a good idea to have a digital backup of the form, either on your device or in a cloud-based storage service, to ensure you have access to the information in case the physical copy is lost or damaged.

How can emergency responders effectively inform emergency contacts?

A responder should inform emergency contacts promptly and empathetically, providing clear and concise information about the situation and the individual's condition while offering reassurance and guidance on the next steps if necessary.

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