Time for Technology

Fill out the form below and check all the fields that apply. If you check two or more, you should consider a medical alert system.

Assessment Tool

pdf Download the “Is it time for a Medical Alert System?” checklist

First Name:
Last Name:
Email:
Telephone:

 
Check all Fields that Apply:
Live alone or is left alone by caregiver for extended periods
Alone for extended periods of time
Have a least one chronic illness, such as heart disease, stroke, diabetes, pulmonary issues, osteoporosis or arthritis
Feel nervous to be alone due to a medical concern or unsafe living environment
Use mobility assistance devices such as walkers, canes, crutches, a wheel chair etc.
Require assistance performing activities of daily living, such as walking, bathing, toileting, meal prepration etc.
Physical or sensory impairments (vision, hearing, walking etc.)
A history of falls or medical emergencies
A hospitalization within the last 12 months
A history of medication management issues