Elderly/Disabled/Shut-In/Wander Alert

2. 
4. Someone will be happy to assist you Monday - Friday between 8:00 a.m. and 5:00 p.m.The information you provide will be placed in a log and accessible to our police officers, should your loved one wander, be in need of a home check, or be in need of help during a large scale emergency or disaster.
6. Check all that apply

   1. Elderly
   2. Disabled
   3. Shut-in
   4. Wanderer
   5. Alzheimwer's
   6. Dementia
   7. Diabetic
8. Other diagnosed illness (please describe if applicable)
10. Name and DOB of Person *
12. Their Address*
14. Their Primary Care Physician's Name/Number *
16. Your Name *
18. Your Relationship*
20. Your Address*
22. Your Phone Number (s)
24. Any other information you wish to share
26. Upload a Pictures
28. You may Upload Photographs or Mail Information or deliver in person to: Norwood Police Department 4701 Montgomery Rd, Norwood OH. 45212
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29. 1. Receive an email copy of this form.
30. Email address

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31. Submit

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