Professional Monitoring Registration Form

Professional Monitoring Registration Form

Please complete this form to enable us to set up your device

Customer To Fill In
CareMate Order Number #*
You will find this on your order confirmation email
Purchaser Details
Full Name*

First NameLast Name
Company Name (If Applicable)
Address*

Street Address

Street Address Line 2

CityState

Post Code
Mobile Number*
E-mail Address*
example@example.com
Relationship To Device Wearer*
How Did You Find Out About Us?*
Device Wearer's Details
Full Name*

First NameLast Name
Date Of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState

Post Code
Mobile Number *
Email Address
example@example.com
Device Wearer Category*
Does Wearer Have Wifi At Premises?*
Standard Procedure

SOS Button and Fall Detection
- If the User is in distress and presses the emergency SOS button on the device, or a fall is detected, the device will play a voice prompt up to 3 times to warn the User prior to sending an alarm.
- If the User wishes to cancel this at all they can tap the SOS button to cancel it before the end of the 3rd voice prompt.
- After the 3rd voice prompt the device will send an emergency message to the monitoring centre with the User’s location.
- The monitoring centre will then call the device to verify the type of response needed.
- The device will automatically answer the call handsfree on speaker mode.
- The User's pre selected contacts and Emergency Services (if required) are then contacted to advise of the situation.
Low Battery Alerts

For extra peace of mind, if the device's battery is at 20% the User will get a voice prompt. At 15% the User will get a voice prompt and a Low Battery message will also be sent to the monitoring centre automatically.
Contact List
Contact 1

Device is 1st Contact
Device Number
Device Mobile Number
Contact 2

Device Wearer
Device Wearer's Name*

First NameLast Name
Device Wearer's Mobile Number*
Contact 3
Full Name

First NameLast Name
Mobile Number
Contact 4
Full Name

First NameLast Name
Mobile Number
Contact 5
Full Name

First NameLast Name
Mobile Number
Contact 6
Full Name

First NameLast Name
Mobile Number
Contact 7
Full Name

First NameLast Name
Mobile Number
* Please Note: A Voice Code is used to identify and verify the wearer when a direct call is made. The Voice Code is always the Device # (which is on back of the device and on the box) This number is unique to each device. Failure to give a valid Voice Code will result in escalation to the nominated emergency contacts.
Voice Code
Device number that will be allocated later
Key Safe Box Code (If Applicable)
Any Additional Information Monitoring Centre / Emergency Services Should Know
Eg. Wearer is hard of hearing / Issues with access to property
Should be Empty:

Professional Monitoring Registration Form

Purchaser Details

Device Wearer's Details

Contact List

Contact 1

Contact 2

Contact 3

Contact 4

Contact 5

Contact 6

Contact 7