Emergency Contact Form

This emergency contact template is a simple way to collect and track important contact information for your loved ones or employees in case of an emergency. Use this free template to create your own incident contact form and ensure you have all the necessary information at your fingertips when you need it most.

Customize in minutes

Drag and drop 40+ customizable question types to make this template your own.

Scheduling

Calendly, Chili Piper, cal.com

File uploads

Securely collect documents

Email address

Work or personal

Mailing address input

Autocomplete with the Google Maps API

Collect phone numbers

Domestic or international

Captcha

Verify human respondents

+ dozens more

Connect to
Notion

Send responses wherever you need them, in 60 seconds:

1Clone this template.

2Connect your integration in Fillout.

3Share a link or embed forms anywhere ⚡️

Template FAQs

Why do I need an emergency contact form?: An emergency contact form can be a lifesaver. In case of an emergency, you want to be sure that the right people are contacted immediately. By filling out an emergency contact form, you ensure that your loved ones and friends can be reached if something happens to you. It also helps to inform first responders, medical personnel, or anyone in charge of your care, about any critical health conditions you may have.
What information should I include in an emergency contact form?: Your emergency contact form should include your full name, date of birth, and contact information, as well as the names, relationships, and contact information of at least two emergency contacts. It’s also a good idea to include information about any medical conditions, allergies, or medications you’re taking. This information can help medical professionals provide you with the best possible care in an emergency situation.
Can I customize my emergency contact form?: Absolutely! You can customize your emergency contact form to fit your specific needs. You can add additional fields to collect information that may be important in an emergency situation, such as your blood type, health insurance information, or any special instructions for your emergency contacts. You can also choose the format and design of your emergency contact form to make it easy to read and understand.
How do I access my emergency contact form?: Once you’ve created your emergency contact form, you can access it at any time on any device with an internet connection. This means that in an emergency, you can quickly and easily access your emergency contact information from your phone or tablet. You can also share your emergency contact form with your family and friends, so they have access to your information as well.
Is my emergency contact form secure?: Yes. We take the security of your information very seriously. Your emergency contact form is stored securely and is only accessible to you and the people you choose to share it with. We use state-of-the-art security measures to protect your information, including encryption and two-factor authentication.