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Thanks for your interest in Easy Does it Emergency Services. If this is your first time using our services we need to verify that you're eligible. The first step is to apply online, after which, a team member will follow up to get your account setup. * indicates a required field.

Page 1

Contact Details

Disability Information

Select all that apply
Measure E Qualifications

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

Address Information

Page 2

Phone Contact Information

Email Contact Information

Emergency Contact Information

Age Information

Demographic Information

Page 3

Income Information

Please refer to table below for guidelines
Poverty Guideline Table
Household Information

Page 4

Health Insurance & Education

Reduced Co-pay Information

East Bay Paratransit & BRSD

In Home Support Services Information

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