Signup Form - Caregiver

teleCalm Service Application

Primary Caregiver (Account Holder) Information

teleCalm accounts are in the caregiver's name, not the name of the loved one.

Unlike traditional phone service, teleCalm considers the caregiver to be the account holder and their loved one to be the end-user. This allows the caregiver to be the primary point of contact for any questions and support interactions regarding the account.

Caregiver First Name

Caregiver Last Name

Caregiver Email Address

This will also be your user-id for the teleCalm Caregiver app

Caregiver Cell Number

Primary caregiver may receive service-related alerts

Any additional details you can provide would be great!

Do you know how they found us?

What is the name of the senior living community?

Any idea what you searched for? Did you use Google, Bing, DuckDuckGo, etc.?

Was this in-person or online? Can you provide the name of the group?

Do you recall what website?

Shipping Address

Where should we ship the teleCalm adapter? This is usually the primary caregiver's address or another family member that lives near the loved one. On rare occasions, this may be a senior living community, but it is not recommended.

Ship To Name

(if different from Caregiver)

Street Address

Street Address 2

City

Zip code

End User Information

Where will the adapter be located? This would be the physical address, including apartment or room number of the loved one.

This will also be used as the 911 address that emergency dispatchers will see if 911 is dialed.

Loved One's Name

What is your loved one's full name (first last)

Loved One's Age

Optional, but helpful

Community Name

Service Address

Apt / Room #

Service City

ZIP

Why are we asking about internet?

teleCalm provides phone service that's easy to set up using our adapter. You can use it with the senior’s dedicated internet, but if they don't have internet, don't worry – it works just fine without it.

If they have internet, we'll send a cable to connect the teleCalm device to the internet box.

If you don’t have internet, the device will use its own built-in cellular service to keep them connected, as long as there is good cellular coverage in the resident's home/apartment. Here's a quick video showing the easy setup.

Needing to keep the old phone number?

teleCalm provides a brand new phone number for your convenience. Many subscribers find that starting fresh is easier, especially when only adding a small number of trusted contacts.

However, if you need to port an existing phone number, we can help process that port request on your behalf, but it is NOT immediate. This process can take 2-3 weeks and there will be a $25 charge once porting is successful. More info on porting can be found here.

Any special instructions?

teleCalm's Terms of Service, including SMS messaging terms

All teleCalm subscribers must read and agree to teleCalm's Terms of Service, including SMS messaging terms, and grant teleCalm express permission to send automated and customer service-related text messages to my mobile phone [field17].

By checking this box you agree to receive recurring messages from teleCalm, Inc, Reply STOP to Opt out. Reply HELP for help. Message frequency varies. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages.

Sorry, all subscribers must agree to our terms of service

Please contact teleCalm with any questions or concerns at 888-701-0411

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