For help with questions or to order, please call
(866) 633-2576

Order Form

The PAL Annual Plan
$19.95 per month
12 month contract

The PAL 6-Month Plan
$24.95 per month
6 Month Contract

The PAL Monthly Plan
$29.00
No Contract

The MD2 Monthly Plan
$89.95
No Contract

Please use the form below to email us to arrange service or to answer additional questions about the PAL Personal Alert Link service.

When you have completed the form click “Submit Form” and our knowledgeable customer service representatives will get back to you within 48 hours.
The information you provide here is only used by Personal Alert Link (PAL). It is never sold to or shared with third parties.
Asterisk (*) indicates required field.

I am interested in information about The PAL

My Name*:

My Phone*:

(ex.555-555-5555)

Alt Phone:

(ex.555-555-5555)

My Email*:

(ex.john@smith.com)

Comments:

Select your PAL Plan Type

PAL Plan Type*:

PAL Annual Plan
PAL 6-Month Plan
PAL Monthly Plan
MD2 Monthly Plan

Who will be using The PAL?

Select all that apply*:

Myself
Friend or Relative
Patient or Client

Customer Requiring Service (if other than yourself)

First Name:

Last Name:

Address:

City:

State:

ZipCode:

(ex.55555)

Phone:

(ex.555-555-5555)