Let's get you signed up

Thanks for your interest in our emergency services! We're thrilled you're ready to start using them to enhance your independent living situation. Here's what you need to do to get enrolled.

We encourage all of our clients to review our updated Service Guidelines. We've created these documents to ensure that both our clients and team are treated with respect, while also ensuring quality services for you. Repair Clients are required to sign a waiver before their first repair call. Repeated failures to comply with the rules set in these documents could result in us restricting or terminating the usage of our services. Thanks for your understanding and cooperation.

Repair Liability

Repair clients will be required to sign a release waiver in order to use our services.

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Service Guidelines

All clients and team members are expected to adhere to these guidelines.

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Loaner Program

Terms for usage of our loaner equipment. We may charge for damage done to our power chairs.

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BRSD Program

An update regarding how you can use BRSD vouchers and future disbursements.

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Thanks to The City of Berkeley's Rides for Seniors and the Disabled Program (BRSD.) We're able to provide our clients with free door through door transportation. In order to start receiving vouchers for free rides, you'll need to complete a separate application with them.

Voucher Application

Fill out this form then submit it to: Berkeley Rides for Seniors & the Disabled, 1901 Hearst Avenue Berkeley, CA 94709 OR email application to BRSD@berkeleyca.gov.

Once you've submitted your application for BRSD, it's time to register as a client with us. Please complete the form to the best of your ability. All information shared is strictly for reporting on our work to The City of Berkeley. Your identity is never shared, only demographics.

The only thing we verify is your Address: Before you begin your application please confirm you provided the correct ZIP code. If our team discovers your address differs from the information provided you will not be approved for service.

Clients that fall below the Federal Poverty Line can also apply for reduced copayments. If our paid services are a significant financial burden, just provide us with two forms of income verification and pay just 7.50 an hour/10 miles of transportation.

Start my Application

Apply for Service

Thanks for taking the time to verify your eligibility for Easy Does It Emergency Services. Please fill out all the required fields to complete your application for service. Upon completion of this form, we'll review your application for accuracy and notify you via e-mail when you are approved.

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1 Uppercase letter
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1 Number
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Contact Details

First Name

Last Name

Contact Type

Referral

Disability Information

Primary Disability

Speech Disability

Other Disabilities

Select all that apply

Measure E Qualifications

Do you live or work in Berkeley?

Are you visiting Berkeley?

Do you need personal assistance with least one activity of daily living due to substantial disability-related limitations?

Examples: dressing, meal preparation, transferring, toileting, housekeeping, taking medication, mobility

Qualifies for Measure E

UCB Affiliation

Affiliation

Address Information

Primary Mailing Address Type

Mailing Street

Mailing City

Mailing State

Mailing Zip/Postal Code

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Phone Contact Information

Preferred Phone Type

Home Phone

Work Phone

Email Contact Information

Personal Email

Would you like to be added to our email list?

Would you like to receive your invoice electronically?

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Age Information

Birthdate

Age Range

Demographic Information

Gender

Race

Hispanic or Latino?

Veteran Status

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Income Information

Yearly Income

Source of Household Income

Non-Cash Benefits

Other Income Source

Level of Household Income

Please refer to table below for guidelines

Household Information

Housing Type

Household Type

Number of Persons in Household

Single Female Head of Household?

Number of Minors in Household

Work Status (18+)

Are you between the ages of 14-24 and do not work or go to school?

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Health Insurance & Education

Health Insurance Source

Education Level

East Bay Paratransit & BRSD

Do you use East Bay Paratransit?

Do you know about the Berkeley Rides for Senior and Disabled Voucher Program?

Are you signed up for Berkeley Rides for Senior and Disabled Voucher Program?

Preferences

Do you have a gender preference for an attendant/caregiver?

If the caregiver of your preferred gender was not available would you use EDI's services?

You answered No or Maybe to the previous question, please explain how you would get your needs met?

In Home Support Services Information

Do you receive In Home Supportive Services (IHSS)?

Are you a Regional Center Client?

Registration Date

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Let's get you signed up

1 | Review Service Guidelines

Repair Liability

Service Guidelines

Loaner Program

BRSD Program

2 | Apply for BRSD

3 | Apply for Our Services

4 | Apply for Reduced Copayments (Optional)

Apply for Service

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