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SimpleMed Order Form

  • SimpleMed Medical Alarm and Medication Management System

    Complete the following form and a sales representative will contact you within 24 hrs to complete your application and answer any questions you may have.
    Should you not require a medical alarm, the SimpleMed can be ordered as a stand alone medication management device.
  • Your Contact Information

    Information with an asterick (*) is required.
  • Person Using the Service (if other than yourself)

    This information is not required but would be helpful in completing the application form.

 

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