This is an application to become a member of the Medic Alert Program.
TO JOIN BY PHONE, call 1-800-432-5378 any time.
Please have the following information ready:
Credit card number and expiration date
Medical information
Name, telephone number and address of primary physician, and the name and phone number of emergency contacts
Bracelet size (when ordering bracelet)
To join by mail,
download this pdf
, print it out, and mail it in.
Copyright ©2005 Michigan Heart & Vascular Institute. All rights reserved.
