PAASA Order Form

If you'd like to discuss our connected care solutions or require assistance completing this form, you can get in touch with our team using this contact form or by calling our friendly team on 1800 603 377.

Product Selection

In-Home Alarm Solution (PERS)

In-Community Alarm Solution (MPERS)

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Tunstall Lifeline Digital & Vibby Fall Detector

Our in-home alarms are easy-to-use, robust and low-maintenance (no charging required). This makes them ideal for day-to-day coverage under a roof or in the garden – providing for an activation range of 50-80 metres from the home. The compatible Vibby falls detector (wrist or neck worn) is light & unobtrusive.

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Tunstall Gem Mobile Alarm

For support outside the home, the Gem4 pendant or Gem5 watch offers two-way communication, GPS functionality and integrated fall detection, providing peace of mind wherever you go. Providing for reliable mobile reception and a daily recharge, these devices may also be used inside the home.

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Tunstall Gem4 - PendantTunstall Gem5 - Wrist-worn

IMPORTANT: If the client has a pacemaker, we will supply the Tunstall Gem4 with a key ring and carabiner belt clip. Falls Detection is not available with this wearing mode option.

Does the Client have a Pacemaker *

YesNo

Fall Detector Wearing Mode *

NeckWrist

Alarms & Accessories Covered Under Warranty

Lifeline Digital - 24 Month Warranty
Vibby Falls Detector - 12 Month Warranty
Gem4 & Gem5 - 12 Month Warranty

Please Note: GSM medical alarms work only in areas with sufficient mobile coverage. To check the suitability of coverage in your area please visit: https://www.telstra.com.au/coverage-networks/our-coverage.

Customer Details

This will be the person using the alarm, as per the information from your Letter of Approval.

P Code *Purchase Approval Code

M Code *Monitoring Approval Code

Title

Date of Birth *

First Name *

Last Name *

Residential Address Details *

Street Address Line 1 *Street Address Line 2

City *

State *

Postcode *

If this address has an identifier such as a building name or community name, please advise in Address Line 1

Phone Number *e.g. 0412 345 678 or 07 4444 5555

Alternate Phone Numbere.g. 0412 345 678 or 07 4444 5555

Email Address

Emergency Contact Details

Please provide details of first person who has agreed to be contacted in the event that the alarm user requires assistance. Remember the nominated contact should: live within a reasonable distance, be contactable by telephone and willing to respond in the event of an emergency.

Name *

Phone Number *

Relationship

Email Address

How can I provide more emergency response information?

Should the alarm user, or anyone authorised on their behalf, wish to submit further emergency response information (e.g. additional contacts, medical history, after-hours access instructions), they’re welcome to complete an online Client Information Form at any stage.

An invitation to complete this form will be emailed to yourself & the client directly (if their email was supplied) following submission of an order. You can also access that form by clicking here.

Installation

Installation Options *

Self-Installation: I can install the alarm myself, or I have somebody who can assist me.Technician-Installation: I require a Tunstall-approved technician to transport & demonstrate equipment.

Do I require a professional installation?

As our alarms are user-friendly to install, they're usually delivered by courier for a self-installation. Our friendly Customer Service team is also standing by during business hours to provide gentle assistance over the phone.

Installation InstructionsPlease advise alternative installation contact or any additional instructions for the assigned technician.

Delivery Address *

Client Residential AddressAlternate Address

Receiver Name *

Address Name

Street / PO Box *

Suburb *

State *

Postcode *

Installation Notes

Permissions

I have read and agree to Tunstall's Personal Emergency Response Service Authorisation & Privacy Statement.

*

Signature *

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Date

Tunstall Australasia Pty Ltd trading as Tunstall Healthcare ABN 44 059 121 863

1/56 Lavarack Ave, Eagle Farm QLD 4009

t: 1800 603 377 e: au.info@tunstall.com w: tunstallhealthcare.com.au

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