Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Flood Evacuation - Special Medical Needs Form

  1. Riley County EMS

    2011 Claflin Rd. Manhattan, KS 66502

    “The Flood Evacuation – Special Medical Needs Form is intended for individuals or their loved ones who’s health condition would necessitate additional resources should an evacuation become necessary or should their homes lose power or be damaged by water. Please be as detailed as possible when completing the form. Once received, Emergency Services from Riley County and the City of Manhattan will store the information provided to be used to allocate resources as efficiently and effectively as possible.

  2. Special Medical Needs*

    Check all that apply:

  3. By electronically signing this form you are agreeing to the validity of all information obtained within.

  4. * indicates a required field

  5. Leave This Blank:

  6. This field is not part of the form submission.