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  HomeProgramsAre You Ok? > Field Interview Form

The Field Interview Form will be added shortly.  This form will provide us with the information we need in order to taylor the program to your needs.  Here are a few of the questions that will be asked:

  1. Your name and address
  2. Emergency Contact information
  3. Name of your doctor and clergy
  4. Next of Kin
  5. Any key holders to your home
  6. Do you have any pets
  7. Do you live alone
  8. Any physical impairments

The reason for some of the questions will be explained to you as you fill out the form.  It will be extremely important to answer all the questions as completely as possible.  Remember if a deputy or police officer is dispatched to your residence because we have been unable to make contact with you they may have to force their way into the house to check on you, that is why we ask if there is anyone else with a key, if you have pets and if you live alone.  Our primary concern is for your safety and for the safety of your loved ones.

You can download a copy of the form here (It may take a few minutes to load).  Print the form out and bring it by our office located at 1900 Frederick Road in Opelika.  If you are unable to download the form you can come by the Lee County Sheriff's Office and pick one up.