Dixie Emergency
Ambulance Billing
Dixie County - Special Needs Registration

This program is designed for those who have special physical and/or medical needs and may require government evacuation and/or shelter assistance in the event of an emergency.

This information is requested pursuant to Section 252.355, Florida Statutes, which also mandates that all information contained within is confidential and exempt from disclosure and can be made available only to other emergency response agencies.

This form should ONLY be completed if you plan to use a Public Shelter during an emergency

Note: In the event of an actual emergency, response agencies will attempt to provide the necessary assistance but because of significantly increased demands on government resources, this cannot always be assured. To best guarantee personal safety, individuals should take the necessary advance precautions and follow planning guidance issued by government response agencies. Should you require special/ambulance transportation and/or hospital facilities, you must make those arrangements yourself.

Special Needs individuals going to a shelter should be accompanied by their personal care-giver.

The management of nursing, convalescent, retirement, and other group facilities
are responsible for the evacuation and sheltering of their own residents.

Please complete ALL 3 Steps of the Registration Process. Your Special Needs Registration will not be completed until you click the "Complete Registration" button at the end of Step 3.


Please confirm you understand and agree with the above statements before moving on to Step 1.


I Have Read and Understand the Above Statements.











Design & Hosting Services Provided By: Wreath Media Inc.