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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
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In Home Support Services Information

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