How to Sign Up
For more information on how to obtain your own personal reassurance alarm, please contact the sales and marketing teams for Meditama Lifecare Malaysia & Telecare Services Singapore:
Kelly Fong (+6) 016 207 1206
Evon Au Yong (+6) 016 226 0312
evon@telecareasia.com
Meditama Lifecare Penang:
Lim York Pinc (+6) 016 226 0309
pinc@telecareasia.com
Telecare Services Singapore:
Lennon Goh +65 9769 4101
For more information or to sign up, please call the Helpline at 1-300 880 318.
You can also download a printable form by clicking here, or you can fill in the online form below.
Please send me more information and updates on Telecare's products and services.
Name you prefer to be known by:
Email:
Home Phone:
Title:
Other:
Surname:
Given Name:
Birthdate:
(Day/Month/Year)
Street Address:
City/Town:
State:
Postcode:
Office Phone:
Mobile Phone:
Main language spoken:
Dialect (if applicable):
Personal Details
I would like to be contacted through: (please tick the appropriate box/boxes)
Phone
Post
Medical Details
What is your body weight?
Below 70kg
70kg to 100kg
Above 100kg
What medical conditions do you have?
Name of personal doctor/clinic:
Doctor's phone number(s):
In the event of a medical emergency, do you authorise us to call for an ambulance?
Yes
No, I would like to make the following arrangements: (please explain below)
I prefer a public ambulance
I prefer a private ambulance (please specify which)
In an emergency, is there a way to enter your dwelling without forced entry (i.e breaking down the door)?
Yes, my neighbour has a key
No, I would like to make the following arrangements: (please explain below)
Yes, I have a hidden key
Emergency Contacts
Please list down details of relatives and neighbours who we can contact in the event of an emergency.
Name
Relationship
Contact Number(s)
Does this person have access to your property?
Yes
No
Name
Relationship
Contact Number(s)
Yes
No
Does this person have access to your property?
Name
Relationship
Contact Number(s)
Yes
No
Does this person have access to your property?