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Freecall 1800 813 617

Applying for a Safety Link service is easy. This on-line form is a convenient way to submit your application request.

By simply filling out the required fields, we will have sufficient information to get your request underway. A courtesy email copy of the application will be forwarded to the email address nominated in the submission to confirm the receipt of your request.

Our consultants will contact you on the next business day to confirm details to create an accurate emergency profile and also explain the set up process of the alarm service.
 
Call us on Freecall 1800 813 617 if you require assistance.

Client Information

* Indicates mandatory field
Title *
Full Name *
Address *
Suburb *
State *
Postcode
Client Phone Number *
Date of Birth
Is a spare key or key safe available?
Yes     No
Has the client any problems with?
Eyesight       Hearing       Speech       Mobility
List any significant medical conditions including allergies, pacemaker, or respirator.
Additional client information or requirements
Name of Doctor
Doctor's Contact Number

Emergency Contact #1

Name of Emergency Contact 1 *
Address of Emergency Contact 1 *
Phone Number of Emergency Contact 1 *
Does this person have a spare key? *
Yes     No

Emergency Contact #2

Name of Emergency Contact 2
Address of Emergency Contact 2
Phone Number of Emergency Contact 2
Does this person have a spare key?
Yes     No

Application Details

Application Contact Name
Application Contact Number
Email Address *
Is a power point or power source available for the alarm? *
Yes     No
What type of service do you require?
GO Trek Only       GO Trek with EVE Alarm       EVE Alarm Only      
Additional options (not part of standard service, additional fees will apply)
Daily Call       Additional Pendant       Key Safe Fall Detector Pendant

Billing

Account Frequency *
Preferred Payment Method
Name of person/organisation who will pay account *

Please read our Terms and Conditions

I have read and understood the Terms and Conditions. *

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