Personal Emergency Lifeline Application

Posted 4 months ago

Lifeline Model options you may select include:

In Home Only – Std – Landline required – BOB 3600/4200 – $25 monthly fee
The standard unit is an in home unit that requires a landline. No location tracking available. The emergency response address is your home address.

Cellular In-Home Only Unit
Option 1- standard unit – $35 monthly fee
Option 2 – standard unit + fall detector – $45 monthly fee
The standard unit is an in home unit that requires a landline. No location tracking available. The emergency response address is your home address.

CST 8000 – Mobile PERS
Similar to a smartphone in size
One button to push on the unit for emergencies
This unit can travel with you wherever you go
GPS internal for location tracking
Fall Detector included
$45 / month

Terms and Conditions of applying – by submitting this form, you are agreeing to the following:

I understand that I am responsible for the care of the unit while in my possession, and for its safe return. I am
aware that if I no longer need the unit, it is not transferable to any other family member or acquaintance and I
will contact CST directly to arrange safe return of the unit. If the equipment or part of it becomes lost, stolen or
damaged beyond repair, my estate or I will pay the replacement cost listed below.

Standard In-Home Unit – Replacement Cost – $150.00
– Additional Help Button Replacement Cost – $45.00

Cellular In-Home Unit – Fall Detector Emergency Medical Alert System Replacement Cost – $270.00
– Additional Help Button Replacement Cost – $65.00

CST 8000 Mobile PERS – Replacement Cost: $259.00

In the rare event my unit or its components malfunction, I should call CST to alert them, and I will contact a
family member or responder to check in on me until such time as an installer/technician is available to correct
the problem. I have read and fully understand and accept the guidelines and terms of the CST Program.

Hidden Key / Lockbox:

A hidden key is not a requirement, but is strongly suggested for emergency purposes when a responder,
EMT’s or police are unable to enter your residence. The subscriber understands if a call for help is received and the subscriber cannot answer the door for 1) listed responder, or 2) an emergency responder (police, EMT’s), responder may need to break into the subscriber’s home, possibly causing damage. The subscriber accepts these terms and agrees not to make any claim against the responder, Medical Center Foundation of Hartford or Critical Signal Technologies for damages caused by forced entry.

Apply Online

Who is the subscriber? (The person using the lifeline)

A valid phone number is required.
A valid phone number is required.
A valid email address is required.

Please answer the following medical background questions and provide us information on your doctor as well as preferred hospital

A valid phone number is required.
A valid phone number is required.

Provide us with a family contact that should be called in case of an emergency, account issue or billing matter

A valid phone number is required.

Choose your lifeline model from our available options:

Complete the following fields if your spouse needs a lifeline as well

A valid phone number is required.
A valid phone number is required.

Billing Contact (if other than self)

A valid phone number is required.

Installation Contact: Who shall we call when our installers are ready to install your CST unit?

A valid phone number is required.

Who shall we call in the event a lifeline is activated for a non-emergency need? Please list two contacts.

A valid phone number is required.
A valid phone number is required.
A valid phone number is required.
A valid phone number is required.

Terms of conditions acceptance