LifeGuardian New Subscriber Registration Form

Simply and quickly update subscriber information!

Please take a few minutes to complete the Update Subscriber Information Form and your order will be transmitted electronically direct to the LifeGuardian Customer Service office. Updates are generally inputted into the system within one business day.

If you prefer, click here to print out and FAX your Update Subscriber Information Form.

Please Note: * Indicates required field.

1. Subscriber (User) Information
LifeGuardian Account Number:
*Subscriber (User) Name:
*Physical Address:
Apartment/Unit #:
Nearest Cross Street:
*City
*State:
*Zip Code:
*Telephone Number: (Please Include Area Code)
Email Address:
Location of Hide-A-Key :
Key Safe Combination:
Property Access Code:
2. Critical Medical Information
Date of Birth:
Blood Type:
Preferred Hospital:
Medical Conditions:
Required Medications:
Known Allergies:
Special Instructions:
3. Emergency Contact List
Contact #1
Full Name:
Full Phone Number: (Please Include Area Code)
Phone Location:
Relationship to Subscriber:
Contact Has a Property Key?
Contact #2
Full Name:
Full Phone Number: (Please Include Area Code)
Phone Location:
Relationship To Subscriber:
Contact Has a Property Key?
Contact #3
Full Name:
Full Phone Number: (Please Include Area Code)
Phone Location:
Relationship To Subscriber:
Contact Has a Property Key?
Contact #4
Full Name:
Full Phone Number: (Please Include Area Code)
Phone Location:
Relationship To Subscriber:
Contact Has a Property Key?
Contact #5
Full Name:
Full Phone Number: (Please Include Area Code)
Phone Location:
Relationship To Subscriber:
Contact Has a Property Key?
Contact #6
Full Name:
Full Phone Number: (Please Include Area Code)
Phone Location:
Relationship To Subscriber:
Contact Has a Property Key?
4. Optional Products & Services
5. Service Agreement Acceptance
*Agreement Acceptance
*Accepted By (Type Name):
*Date Completed:
*Phone Number:
*Email Address