In accordance with Virginia Law, the City of Roanoke provides this form allowing citizens to submit information into a voluntary database. This database is available to the City of Roanoke E911 center to provide relevant mental health information and emergency contact information to our Public Safety responders in an emergency or crisis. Identifying and health information concerning behavioral health illness, mental health illness, developmental or intellectual disability, or brain injury may be voluntarily provided to the database by the individual. The parent or legal guardian of an individual may provide this information if the individual is under the age of 18 but that information will be removed from the database when they reach the age of 18 unless the individual or guardian requests it remain. Information is associated with the individual based on the addresses provided.
Information provided to the database shall not be used for any other purpose except as set forth above.