Feedback for "Person at Risk" Program

The Commission on Disability, in collaboration with the Hopkinton Police Department, is seeking feedback on the HPD's "Person at Risk" form. This form helps first responders identify special considerations for residents with mobility issues, cognitive issues, neurodiversity, mental health diagnoses, or any other factors that can keep community members safe during interactions with our emergency responders.    

This survey will help us to determine what questions should be added to or changed on the Persons at Risk form in order to make it more useful for a wider variety of people. 

This form does not constitute registration for the "Persons at Risk" program. 

(Here is the PDF version of the form, if that is easier to navigate.)

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Name (Optional)
Email (Optional)
What organization do you represent? (The answer can be none if you are not responding on behalf of an organization) *
What is your relationship to the person for whom you would submit this form? 
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What individuals help care for you? Please include family, friends, paid caregivers, and caregivers outside of the home. 
What disability(s) and/or medical conditions do you have?
Do you feel that this form addresses your disability(s)? If not, what is missing?
Do you feel that this form is readable and understandable? If not, what could be clarified?
What considerations about your physical function might be important for emergency services to know that are not included on this form?
What consideration about your mental function might be important for emergency services to know that are not included on this form?
What considerations about your emotional function might be important for emergency services to know that are not included in this town? 
What considerations about your sensory function might be important for emergency services to know that are not included in this form?
What considerations about your health might be important for emergency services to know that are not included in this form?
What additional functions and considerations might be important for emergency services to know about that are not included in this form?
What considerations about your housing might be important for emergency services to know?
What considerations might be important if you are outside of your home?
Do you have assistance animals or protective pets that would be important for emergency services to know about? 
What considerations about your transportation needs when being transported by others might be important for emergency services to know? 
Please provide any additional feedback you may have on the current version of the "Person at Risk" form. All feedback welcome. 
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