Senior Information Form
The purpose of this form is to identify homebound seniors within Floyd County in need of assistance. If you are in such a situation, please provide your information below to show your desire to be added to the database. Depending on the selected services, information will be shared with EMS and potentially the Sheriff's office, if the requested option is through the Sheriff's office. Basic information will be retained by the Floyd County Administration, HIPPA data will be retained by EMS.