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info@smartcompanion.care

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Thank you for placing your order with SmartCompanion

Please provide the following information to complete your order:

Order Details

Name: Jon Sample

Address: 731 San Pablo Drive, Munster, IN 46321

Order ID: #123

Order Placed Date: 04/01/2020 10:34

Additional Information

Referring Agency Name

State

City

Does the customer have internet access?
Yes No

Does the customer have cellular coverage in their home?
Yes No

Name of cellular provicer:

Areas where calls Drop
Yes No

Emergency Contact 1

Name

Phone

Email

Relation

Key Holder Emergency Contact
Yes No

Verify Before EMS

Dispatching EMS

Dispatch EMS if Customer Request

Dispatch EMS if No Response Is Given

DO NOT DISPATCH EMS ON CUSTOMER REQUEST, instead use contact verification list

(This means that EMS will not be dispatched unless a contact is reached first)

Hidden Key Location / Locbox Code

Social Contact 1

Name

Phone

Email

Relation

Responsible Party

Same as billing

Name

Phone

Email

Relation

Special instructions

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.

For Living Facilities

Marketing Materials

Data Privacy Policy

Terms and Conditions

CONTACT INFO

855-488-1081

info@smartcompanion.care

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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