The greatest achievement of the human spirit is to live up to one's opportunities and make the most
of one's resources.

Vauvenargues, Marquis de quotes (French moralist and essayist, 1715-1747)

Breathe Easy Through
Organized Living!

product page

My Wise Guides Emergency Information Wallet Card

Generate your own Emergency Information Wallet Card by simply completing the
form below.

NOTE: your information is NOT stored on this site. If you want to update or change the information in the future you will need to start the process over.

Steps:

  1. Fill in your personal information.
  2. Click on the button “Create Your Emergency Information Wallet Card” and this will pop-up a new window with the emergency card.
  3. Review all the information.
  4. If you need to change or add information return to the form.
  5. Once information is complete print it out by selecting the button "Create Your Emergency Wallet Card Now" (NOTE: your information is NOT stored on this site. If you want to update or change the information in the future you will need to start the process over.)
  6. Cut out the form, have it laminated, and place in your wallet.

Personal Information
First Name Middle Name Last Name
Address City State ZIP Code
Cell Phone Home Phone Birth Date(dd/mm/yyyy) Blood Group

Emergency Contacts
Name Relationship Home Phone Cell Phone

Pharmacy
Pharmacy Name Pharmacy Phone

Physician/s
Name Type of Practice Work Phone Cell Phone

Current Medical Conditions (ie: heart disease, diabetes, high blood pressure, etc)
1. 2.
3. 4.
5. 6.

Allergies
1. 2.
3. 4.
5. 6.

Medication
Name Dosage (Example: 3mg) Frequency (Example: 2xday, 1xmonth)

I GIVE my consent to treatment
 I do NOT give my consent to treatment 
Do NOT Resuscitate 
DO Resuscitate 
 I have the following:
Living Will
Healthcare Power of Attorney

Note: Your information will not be stored on this site.  If you want to change information on this card you will need  to start the process over. If you wish to print your card push the button below. We make no representations about how accurate, complete, timely reliable or legal this information is in your area. All information is provided "as is" without warranty of any kind. In no event shall we be liable for any indirect, punitive, consequential, incidental, or special damages arising out of or connected with the use of this site or card.