Chicago 311

Submit Senior Information and Assistance Request Request

Location

Enter street address to search.
Long-click and hold on map pin, then drag to adjust location.

Photo

Description

Senior Name

Senior Phone Number

What is the naturre of the request

Senior's Gender

Senior's Date of Birth

Language Spoken by Senior

* Does Client have Alzheimer’s, Dementia or Related Disease (ADRD)?

Receive mobile text updates?

Reporter

First name

Last name

Enter an email address to receive a tracking number

Phone

Enter as 999-999-9999

Senior Information and Assistance Request

This service request is used to request information and assistance from FSS-Senior Services. If a Senior needs the immediate assistance of Police, Fire or Emergency Medical services, please call 911.

Instructions

Describe the issue you wish to report including a photo and/or a description.
* Indicates a required field.