Boone Electric Medical Alert Program

Name (as it appears on electric bill):
  
8-digit Account Number:
  
Address:
  
Daytime Phone:
 
Evening Phone:
  

Check ONE of the following categories which best describes your priority situation:

Life-support (**your equipment supplier also needs to notify our office)

Person with a handicap or disability (letter required from physician)

Elderly living at home

Medical facility (includes any geriatric, retirement or other medical facility)

‹ Previous Page