Membership Assistance Program

The goal of MedicAlert’s Assistance Program is to ensure that any person with potentially life-threatening medical conditions can have access to services offered by MedicAlert, regardless of his/her ability to pay.

How to Apply

Individuals can apply for assistance by completing a Member Assistance Application Form. We ask for a referral from the applicant’s physician or social worker, a nurse or a pharmacist. A completed and signed MedicAlert Registration Form detailing contact information and medical conditions should accompany the Member Assistance Application Form.

To order application forms, please Click here

Order Application Forms