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Phone Number

Office Address

11975 Westline Industrial Drive, St. Louis, Missouri 63146

Email Address

info@smartcompanion.care

Want to learn more
about SmartCompanion?

Reach out to us today to learn how you or your clients
can maintain in-home independence with SmartCompanion.

Contact
info@smartcompanion.care
855-488-1081
Schedule a Call

Office
11975 Westline Industrial Drive, St. Louis, Missouri 63146

I am interested in SmartCompanion for an:

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Individual

Agency

Name of the Person to Contact *(Required)

Name of the person to contact *

Relationship to Referral *(Required)

Email address *(Required)

Phone number *(Required)

Person who needs SmartCompanion

First Name *(Required)

First Name (of person who needs Smartcompanion) Last Name (of person who needs Smartcompanion)

Phone number *

Additional client info

Are you an Agency or Organization?(Required)

Yes

No

Agency Information

Name of the Referring Agency *(Required)

Name of the Referring Agency

Name of Person sumbitting referral *(Required)

Name of Person sumbitting referral

Email Address *(Required)

Address *(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone number *(Required)

Company Name(Required)

Company Name

Agency Name(Required)

Agency Name

Entity Type(Required)

Company Address 1(Required)

Company Address 2(Required)

City(Required)

State(Required)

Zip Code(Required)

+ Add Locations

Company / Branch Name

Address 1

Address 2

City

State

Zip Code

Phone Number

How many years have you been in business?(Required)

How many active clients?(Required)

Are you looking to grow your private pay home care business?(Required)

Yes

No

First Name(Required)

First Name - Agency Last Name - Agency

Your Phone Number(Required)

Your Email Address(Required)

How did you hear about us ?(Required)

Comments(Required)

checkbox 1(Required)

Our agency wishes to participate in the SmartCompanion program in accordance with the Subcontractor Agreement in the Terms & Conditions

checkbox 3(Required)

By Clicking Sign Up, you agree to our Terms & Conditions

checkbox 2(Required)

By submitting this document, I attest that I have the authority to execute this agreement on behalf of the above-named company

I am interested in SmartCompanion for an:

Tabs

Individual

Agency

Name of the Person to Contact *(Required)

Name of the person to contact *

Relationship to Referral *(Required)

Email address *(Required)

Phone number *(Required)

Person who needs SmartCompanion

First Name *(Required)

First Name (of person who needs Smartcompanion) Last Name (of person who needs Smartcompanion)

Phone number *

Additional client info

Are you an Agency or Organization?(Required)

Yes

No

Agency Information

Name of the Referring Agency *(Required)

Name of the Referring Agency

Name of Person sumbitting referral *(Required)

Name of Person sumbitting referral

Email Address *(Required)

Address *(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone number *(Required)

Company Name(Required)

Company Name

Agency Name(Required)

Agency Name

Entity Type(Required)

Company Address 1(Required)

Company Address 2(Required)

City(Required)

State(Required)

Zip Code(Required)

+ Add Locations

Company / Branch Name

Address 1

Address 2

City

State

Zip Code

Phone Number

How many years have you been in business?(Required)

How many active clients?(Required)

Are you looking to grow your private pay home care business?(Required)

Yes

No

First Name(Required)

First Name - Agency Last Name - Agency

Your Phone Number(Required)

Your Email Address(Required)

How did you hear about us ?(Required)

Comments(Required)

checkbox 1(Required)

Our agency wishes to participate in the SmartCompanion program in accordance with the Subcontractor Agreement in the Terms & Conditions

checkbox 3(Required)

By Clicking Sign Up, you agree to our Terms & Conditions

checkbox 2(Required)

By submitting this document, I attest that I have the authority to execute this agreement on behalf of the above-named company

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For SmartCompanion technical support, call 855-488-1081

Using Alexa technology, SmartCompanion creates a personalized, whole-home system of smart medical alert devices to help seniors maintain an independent lifestyle and provide caregivers with peace of mind.

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CONTACT INFO

855-488-1081

info@smartcompanion.care

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For Myself or a Loved One

For Agencies and Businesses

Are you an active or
retired military veteran?

Does the SmartCompanion user have an in-home internet modem?

We are pleased to provide our secure cellular WIFI connection for clients without in-home internet equipment, like a modem,
or those without reliable internet connection for an additional $10.

YES	NO +$10/month for cellular WIFI connection

Does the SmartCompanion user have an in-home internet modem?

We are pleased to provide our secure cellular WIFI connection for clients without in-home internet equipment, like a modem,
or those without reliable internet connection for an additional $10.

YES	NO +$10/month for cellular WIFI connection