Signup Form - Priority Response (over internet)

teleCalm Priority Response Subscription

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 person that will be using the phone.

Even though emergency calls will be answered by Priority Response, we still need this 911 address in case ambulance/fire/police need to be dispatched.

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

Existing Internet Required

The plan you’ve chosen requires existing internet service. If your loved one does not have internet in their home, we can provide service using the adapter’s built-in cellular connection for an additional $10 per month.

The teleCalm adapter also provides free backup connection using built-in cellular during unexpected brief internet outages.

Existing Internet Required

The plan you’ve chosen requires existing internet service, either in your loved one’s apartment or via free community WiFi in senior living communities.

If internet is not available, we can provide service using the adapter’s built-in cellular connection for an additional $10 per month.

The teleCalm adapter also provides free backup connection using built-in cellular during unexpected brief internet outages.

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 takes 7-10 days, but can take up to 3 weeks and there will be a $25 charge once porting is successful. More info on porting can be found here.

Any special instructions?

911 Notice -- Priority Response Service

You will be receiving a form via email to complete the Priority Response setup. This will allow you to identify contact phone numbers and describe additional terms of service specific to the Priority Response service. You can cancel the Priority Response service at any time and keep the Caregiver service, if your needs change.

Traditional e911 service will be active until the completed Priority Response agreement is received and configured.

Optional Messaging Authorization (SMS Opt-In)

By selecting YES, I agree to receive SMS updates from teleCalm to the number provided. Message and data rates may apply. Message frequency varies. Text STOP to cancel. View the terms and conditions and privacy policy. SMS messaging authorization is NOT required for teleCalm service.

Updates include direct contact with our Customer Support team and receipt of timely service-related messages.

Subscription PlanHidden Field

Lead Source DetailHidden Field

HubSpot Service AddressHidden Field

Caregiver Full NameHidden Field

Signup DateHidden Field

Client Ref IDHidden Field

Stripe Payment URLHidden Field