Marcus Alert Database

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In compliance with Va. Code Section 9.1-193(F), each locality shall establish a voluntary database to be made available to the 9-1-1 alert system and the Marcus alert system to provide relevant mental health information and emergency contact information for appropriate response to an emergency or crisis. If you are an individual with the behavioral health illness, mental health illness, developmental or intellectual disability, or brain injury; the parent or legal guardian of such individual if the individual is under the age of 18; or a person appointed the guardian of such person, you may voluntarily provide identifying and health information concerning behavioral health illness, mental health illness, developmental or intellectual disability, or brain injury to this database. Provision of such information is completely voluntary. This information will be made available only to the 9-1-1 alert system and the Marcus alert system.

Contact Information

Name
Address

Emergency Contact Information

Emergency contact name

Health Information

Do you have any of the following medical conditions (check all that apply)

Please provide a description of any diagnoses or medical condition(s)

Do you have any allergies?

Resources

Health care provider name

Individual Completing this Form

If you are completing this form for someone else please provide the following information
Name
Consent(Required)

Contact Us

Police

7721 E. Parham Rd.
Henrico, VA 23294

Emergency
911
Police Non-Emergency
(804) 501-5000
General Information
(804) 501-4800

police@henrico.us

Mailing Address
P. O. Box 90775
Henrico, VA 23273-0775

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Please call 911 if you have an emergency.

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