Fill out your form
Step 1 of 3
Complete your emergency medical information: conditions, medications, allergies, and emergency contacts.
Paper form
Emergency Medical Form
A simple medical form and magnetic packet for your refrigerator, one of the first places responders check. The form and packet are free; shipping and handling is $1.99 per request.
How it works
Help first responders find important information quickly.
- 01Fill out your formStep 1 of 3
- 02Place it in the packetStep 2 of 3
- 03Put it on your refrigeratorStep 3 of 3
The refrigerator is one of the first places first responders may check during a medical emergency.
Request Your PacketPlace it in the packet
Step 2 of 3
Your completed form fits into the magnetic emergency packet we provide.
Put it on your refrigerator
Step 3 of 3
Stick the magnetic packet on your fridge where it's easy to find in an emergency.
The packet
What You'll Receive
A clear, easy-to-read emergency medical form and a durable magnetic packet, mailed right to your door. The form and packet are free; shipping and handling is $1.99 per request.
Front and back of the Emergency Medical Form Magnetic packet, ready for your refrigerator The red EMF packet, mailed to your door
Optional donation
Help Us Keep This Free
Optional donations help cover product and shipping costs so we can continue providing free emergency medical forms.
Thank you for your support. Every contribution helps us mail more free emergency medical forms and magnetic packets to families.
Donate100% optional. Your free form and packet are yours regardless.
Mailed to you
Request Your Packet
Your emergency medical form and magnetic packet are free. Shipping and handling is $1.99 per request. Enter your mailing address below to request your packet.