Refer a patient to LifeGuardian Medical Alarms.

Online LifeGuardian Medical Alarm System Patient Referral

Helping Your Patients Help Themselves!

The LifeGuardian™ Medical Alarm System offers Healthcare professionals, nursing & rehabilitation facilities, physical therapists, in-home caregivers and many more a simple program to help your patients in need.

To refer a patient, simply complete the form below and a LifeGuardian™ customer service representative will contact them with complete details.

If you prefer, you may print out and compete this form and FAX your Patient Referral Form to us at 800-209-3813.

HealthCare Professional Online Patient Referral Form

Please provide the following information (* Indicates Required Field)

Patient Information:

*First Name:
*Last Name:
*Home Phone:
Mailing Address:
Mailing Address:
City:
State/Province:
Zip Code:
FAX Number:
E-mail: