Vulnerable Population Registration

“Crises are a bad time to do planning. Only if plans are developed in advance, and then critiqued, rehearsed, and refined, will various agencies and actors be able to respond effectively to a disaster” - Richard Neustadt



As part of preparing to respond to disasters, having as much information in advance is critical to an efficient and timely response. For example, knowing where our most vulnerable citizens live allows us to coordinate with utility providers, non-profits, or other organizations to make sure that citizens' needs are met.

As part of this endeavor, please take a moment to review the form below. This form can be filled out by a patient, caregiver, family member, friend, or anyone else that has the permission of the patient to do so. Please share this form so that we can have an accurate snapshot of the needs in our County. All information gathered will be treated with discretion and accessed only by authorized Emergency Services staff.

 CASPER: The Community Assessment for Public Health Emergency Response (CASPER) is an epidemiological technique designed to provide public health leaders and emergency managers with household-based information about a community.      

  • This form will be uploaded into the NC database for assisting our vulnerable populations in a time of disaster. Please be as thorough as possible, but we also understand and respect your privacy. The completion of this form serves as permission to disseminate this information only as required to render assistance to the registrant.

Google Forms CASPER:

Online Form 


Printable Document CASPER:

Printable Form