0800 037 3745

24/7 Emergency Lifeline Services 

We support your independence at home, with our emergency lifeline alarms.

Sign up to lifeline today!

Welcome to the Response 24 Medical Services Lifeline registration form.
We invite you to fill out this form with accurate and detailed information. After you have submitted the form, a member of our lifeline team will reach out to you within 24 hours to verify your account details and coordinate the delivery of your lifeline device.
Why do we ask for so much information? We want to ensure that we can provide the necessary information to the emergency services if required. Your data is stored in line with our GDPA policy. To find out more information about how we use and store your information, contact us directly. 
Which lifeline device is this agreement for? How would you like to pay for this plan? Service users first name Service users middle name Service users surname Service users mobile phone Service users home phone Service users email address Service users date of birth Service users home address Service users medical history Service users social information Service users NHS number Telephone safe word Does the service user have a DNAR in place Is the service user bed bound? Describe the services users mobility, including walking aids Upload photos of any DNAR/RESPECT/TEP Forms
Upload documents
Is the service user on anticoagulants? If yes, please state anticoagulants Does the service user have a key safe? Emergency contact 1 full name Emergency contact 1 phone number Emergency contact 1 alternate phone number Emergency contact 1 home address Emergency contact 2 full name Emergency contact 2 phone number Emergency contact 2 alternative phone number Emergency contact 2 home address I agree to the Terms & Conditions and Privacy Policy Submit Application