MedFirst Alert

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Person Placing Order

Secure Connection

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                                             Scroll down to complete form.

Person Using System (if different than above)

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Choose Your Plan

You have three different plan options below. The first 4 months of $135.00 is paid upfront and includes shipping and handling.  You will not be billed again until after the 4 month period.
First 4 Months of Service *
Plan Options (check one) *

Credit Card Information

The information below is optional. You may fill it out now or have one of our specialists call and get it from you before your medical alert system is shipped out to you.

Responding Parties to Call (Who would you like us to notify?)
 Responder 1Responder 2Responder 3
Name
Relationship
Phone #1
Phone #2
Has a Key?

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Questions? Call 800-595-0718