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    Home | How to Participate | About Dial-A-Life | Contact Us | miamidade.gov
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    Request a Dial-A-Life Telephone
    Please fill out this form to request a Dial-A-Life Telephone.

    Domestic violence victims do not complete form. Please contact the Domestic Violence Hotline directly 305-748-2546. If you live south of SW 88 Street, please call 305-247-4249.
    First Name *
    Last Name *
    Address *
    City *
    State *
    Zip *
    Phone * Please use dashes xxx-xxx-xxxx
    Category *
    How did you hear about this program?
    E-mail *

    * denotes that these fields are required.
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