Vial of Life Application

* Required

Title

First Name *

Last Name *

Email Address *

Home Phone Number

Cell Phone Number

Home Address

City

State

Zipcode/Postcode

Country

Best time to call:
Mornings
Afternoons

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How to Get Started

To apply for this program, give us a call at 440-205-8111 or use the form to the left to submit your information to us. We will then contact you to start the process of creating a Vial of Life.

Vial of Life

The Vial of Life provides emergency personnel with your vital medical information at the time of crisis. All of Lake County's emergency medical responders are familiar with the Vial of Life and look for it when responding to a 911 call. The Council on Aging will assist you in completing the Vial of Life as well as provide you with the necessary materials and placement instructions. You can then feel secure that your medical conditions, prescriptions, physician's information, and emergency contacts will be available. For an overview of this program, watch the video to the left. This video was created by the city of Mentor.