Medical Alerts

Thank you for choosing Krus Fire & Security, we look forward to working with you. Please fill out the form below and we will get you set up with the medical alert package that best fits your needs. Please do not hesitate to reach out with any questions that you may have!

Customer Information

Customer Using Device:

First Name

Last Name

Phone Number:

(###)

###

####

Service Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Billing Address:

If different from the service address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Call List Information

Please list in order, the people you would like to be contacted in the event of an emergency.

Primary Contact

First Name

Last Name

Phone:

(###)

###

####

Additional Contact:

First Name

Last Name

Phone

(###)

###

####

Additional Contact:

First Name

Last Name

Phone:

(###)

###

####

Order Details

Which package would you like to purchase?

If you selected the Basic Package, do you have a landline?

If you selected the GPS Unit, would you like to upgrade unit to have Fall Detection?

Do you want a technician to install the unit for you?

Is there anything else you think we should know?

Medical Alerts

Location

Hours

Contact