Chicago 311

Submit Senior Well-Being Check Request Request

Location

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

Photo

Description

* What is the nature of this request?

What is the caller's relationship to Senior?

What is the Senior's LAST NAME ?

What is the Senior's FIRST NAME ?

What is the Senior's Phone Number ?

What is the Senior's Age?

Is the Senior male or female?

What language does the Senior speak?

* Is this a CHA property? Yes or No

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Reporter

First name

Last name

Enter an email address to receive a tracking number

Phone

Enter as 999-999-9999

Senior Well-Being Check Request

This service request is used to identify seniors whose health, safety or general well being are in question. The City will send a team of Human Services specialists to make a assessment of the client's needs. Follow-up services can be identified and provided as needed.

Instructions

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