Medically Disabled Resident Recovery
Request Recovery Assistance
Support for medically disabled residents affected by power outages.
1
Resident Information
Tell us about the resident who needs recovery assistance.
Complete the information below so our team can review the resident's needs and follow up.
Medically Disabled Recovery Assistance
*

2
Medication Assistance Needed
Tell us what type of medication assistance you need and how urgent your request is.

3
Pharmacy Information
Provide the pharmacy details so our team can help coordinate your medication pickup or access request.

4
Other Assistance Needed
Let us know if you need help with any additional services or resources so our team can connect you with available support.

5
Consent
Please review and confirm your permission for our team to coordinate assistance, contact service providers when needed, and follow up about your request.

Velocity Solutions CDC
Supporting our community with practical resources, assistance, and access when it matters most.
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