Assistive Technology Services

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Application For A FREE Medical Alert System
Make and model of actual alert system will vary depending on availability.

Please fill out the information below to apply for the Medical Alert System. All applications will be reviewed and if approved you will receive a FREE Medical Alert System when funding is available.
 
We can not guarantee that all applicants will receive the alert system. We will provide as many systems as possible based on funding.
 
Assistive Technology Services promises to use all funds made available to purchase and distribute Free Medical Alert Systems and to not keep any funds for profit.
 
Please describe your health and financial situation in the message section.
 
Your financial eligibility will be verified by local resources.
 
You Must Truthfully Pass The Eligibility Test Below In Order To Proceed.
 

TAKE OUR ELIGIBILITY TEST

To receive a FREE Medical Alert System, you must honestly attest to the statements listed below. 

 
I PROMISE
that neither I nor any immediate family members are financially able to afford a Medical Alert System. (Systems are as low as $69.99)
I PROMISE that I am ordering this Medical Alert for myself.
I PROMISE that I have never previously applied for a Free Medical Alert.
I PROMISE that I will never sell the Free Medical Alert system if I receive one.

I PROMISE that I will learn more about the word of Jesus Christ.

 

If you honestly attested to all of the statements above you may proceed with this application.

 

All information requested below MUST be included in the application.

 
 

Please provide the following information if you desire to continue with this application:

This information pertains to the person actually receiving the medical alert system:


Full Name
Address
Telephone Number
Age
Name of church you attend
Address of church you attend

 

The above information must be included in a letter on the letterhead of the church you attend or from your physician. Any missing information will result in the application being denied.

 

Please mail the letter on church letterhead or physician letterhead to:


FMA Application
8023 Franklin Road
Murfreesboro, TN 37128

 

The amount of time for the application review and funding will vary but usually takes 20-30 days at a minimum. If we are not funded for a free medical alert system at the time the system may not be shipped until we are funded. The amount of time can not be determined. There are no guarantees that any systems will be provided based on funding at the time. All information must be included and mailed. No email requests will be taken

Assistive Technology Services is a Christian based organization and provide these systems with funding from many sources with matching funds from our organization. We rely heavy on the honesty of those requesting these system since there is a huge expense in providing these to the truly needy.