medical & disability needs in disaster

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Are you in the East Bay and needing support in a power outage or dangerous air quality, as early as 10/26? Please complete this form. You can also call us at 910-722-9552 and leave a detailed message. We also have a form where people can leave resources they have available to share at https://tinyurl.com/disresources. We will post updates at facebook.com/disabilityjusticecultureclub
- Stacey and Carrie

Name *

Phone number *

Preferred method of contact *

Phone call

Text

Other:

Address

Neighborhood

City

Accessibility needs

Wheelchair accessible entrance/exit, space to hang out or sleep

Wheelchair accessible bathroom

Fragrance free

Low fragrance

Sober/no substance use in space

Service dog welcome

No cats (allergies)

Minimal steps

Accessible to fat people - chairs with no arms that can support a higher weight, no tiny bathrooms, etc.

Low stimulation space (low light, low noise, etc.)

Near BART

Accessible by bus

Need a ride in wheelchair accessible vehicle

Need a ride (ok if vehicle not wheelchair accessible)

Other:

Do you need support for smoke/bad air quality?

Yes, a place to go with HEPA air purifiers if air quality is severely impacted (air quality "red" or AQI over 150)

Yes, a place with HEPA air purifiers if air quality is somewhat impacted (air quality "orange" or AQI over 100)

I only need this support if my power goes out (and can't run filters/purifiers I have)

Other:

Resources Needed if power off

Electricity - continous to power ventilator, bipap, etc

Electricity - daily to charge cpap, wheelchair, other medical or mobility devices

Electricity - occasionally (less than daily) to charge medical or mobility devices

Refrigerator space for medications

air conditioning

Other:

Can You Tell Us How Urgent Your Need Is and Time Frame It’s Okay to Contact You?

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