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Medical Alarms for Seniors & Healthcare Providers
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Secure Order Form – Quarterly Payment

  • Choose Your Personal Help Button

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  • Client Details

    On this page you first select which style of personal help button you want, this button is included with your service. Next, enter the name, address and county of residence for the person using the medical alarm service.

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  • Add Your Spouse

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  • Phone Information

    Provide details about the phone service at the residence where the service will be used. All medical alarms are designed to work best on traditional phone lines. If your phone service is provided by a VOIP, DSL, or other non-traditional phone provider the medical alarm may not work as expected in all situations.

    A DSL Filter is required to use any medical alarm system on a DSL phone line. You can use your own filter if provided by your phone company, or you can purchase one now with today’s order.
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  • Personal Contacts

    * Enter the information for up to three personal contacts. In an emergency we will attempt to contact these individuals according to your selections for each contact provided. If you do not provide any personal contacts, local emergency services will be contacted when an alarm is received. Do not use 9-1-1 as a personal contact.

  • My First Personal Contact

  • My Second Personal Contact

  • My Third Personal Contact

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  • Special Instructions for Emergency Responders

    Please include any special instructions or details for the Family Care emergency operator and emergency responders. i.e. How can responders get into the house, special directions or landmarks, is there a dog in the home. Only provide important details and keep as short as possible.

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