Designated Employer Representatives (DER), or personnel authorized to make purchasing decisions for a company, use the Authorization Form to request specific services for company employees. The form should be returned with the intended employee, or faxed to us at 214-637-3820.

Use the Company Profile Setup form to open a corporate account with us. Please contact us with any questions at 214-630-1144.

To request their records from us, patients of medALERT will use this form to make their request in writing.

Use this form to remotely authorize a credit card transaction.