Add/Modify My Personal Emergency Contacts

The form below is to update the personal contacts. These are the people you want to respond or to be notified in an emergency. Changes are processed during normal business hours. Please allow up to 24 hours for changes to take effect.

Read Before Using This Form:

• You can complete up to (2) contacts at a time with this form. If you have more contacts start a new form after submitting this one.
• Complete all of the sections on this form.
  Provide at least one valid phone number for each contact.
• Double check your information for spelling and accuracy.
• Only use this form to update information pertaining to your personal contact list.
• Any new contacts added to your account will be placed last in the call order unless specified in the 'notes' section of the change. Existing contacts will remain in the same call order unless otherwise specified in the notes.
  

Important! This step must be completed to process any changes to your account. ( * ) Asterisk denotes a required field

Current phone number where the Alert One system is being used.

*Client's 10-Digit Phone Number

*Client's Full Name (Person Using Alert One)

*Your Full Name (Person Completing This Form)

*Your Phone Number With Area Code (For Verification Call)

Email Address
(If You Want A Copy Of Change Request Sent To You)

 

I need to add/modify the following
personal contact.

 

First Contact I Want To Update

Select One Only:
Add This Person To My Contact List
Remove This Person From My Contact List (Enter Name Only)
This Person Is Already On My Personal Contact List. Here Is Their New Contact Information. (This Option Will Replace All Current Information For This Contact)

 

Name Of Personal Contact
Relationship To Client
Phone numbers for contact: (Example: 555-555-1212)
Call Order	Phone Number	Type Of Phone
1)		Select One Home Work Cell Other
2)		Select One Home Work Cell Other
3)		Select One Home Work Cell Other
Has House Keys		Yes No
In an emergency this person should: Respond Be Notified Both

Any notes or instructions about this contact. (Optional)

Notes

 

 

Second Contact I Want To Update (Optional)

Select One Only:
Add This Person To My Contact List
Remove This Person From My Contact List (Enter Name Only)
This Person Is Already On My Personal Contact List. Here Is Their New Contact Information. (This Option Will Replace All Current Information For This Contact)

Name Of Personal Contact
Relationship To Client
Phone numbers for contact: (Example: 555-555-1212)
Call Order	Phone Number	Type Of Phone
1)		Select One Home Work Cell Other
2)		Select One Home Work Cell Other
3)		Select One Home Work Cell Other
Has House Keys		Yes No
In an emergency this person should: Respond Be Notified Both

 

Any notes or instructions about this contact. (Optional)

Notes

 

By submitting this form you 'agree' that you are authorized to make changes to this account and accept sole responsibility for any errors or inaccuracies in the information provided. You also agree not to hold Alert One Services, Inc. responsible for any damages as a result of the information provided.
"I Agree" with the above statement (required to process)

Click Only Once

Update By Phone

If you prefer to update any account information by phone just call 1-800-693-5433 during Alert One's normal business hours.

As part of your service with Alert One you can make changes to your account information as often as needed at no cost.