Downloads

Authorization Form

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.

Company Profile Setup Form

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

Release of Protected Health Information

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

Single Transaction Authorization

Use this form to remotely authorize a credit card transaction. 

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