Get Subscriber Personal Information - Fraserhealth.ca

Filling out the SUBSCRIBER PERSONAL INFORMATION form for Fraser Health Lifeline is an essential step to ensure you receive timely assistance when needed. This guide provides a clear and supportive breakdown of each section to help you complete the form accurately.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part I - Client Personal Information, enter your first name, middle initial (if applicable), and legal last name. Please ensure that your name matches your official identification. Fill in your residential address, city, province (BC), postal code, and apartment/unit number if applicable. Provide your primary and secondary phone numbers as well as your date of birth in the format of day/month/year.
3. Indicate if this installation is due to a discharge from the hospital and, if so, specify the hospital name.
4. In Part II - Persons Willing to Help, list at least one responder's first and last names, indicating their relationship to you. Provide their phone numbers, how far they live from your home, and if they have a house key. You can list up to three responders, but more options are encouraged.
5. Next, in the section for Next of Kin/Emergency Contacts, provide details for at least one next of kin, which can include their name, relationship to you, and phone number.
6. In Part III - Client Medical Information, check all relevant medical conditions that apply to you and provide details about any significant health issues. Record your primary spoken language, list any known drug allergies, and specify where your medications are kept at home.
7. Indicate your preferred type of personal help button in the PHB section, choosing from cord, wristband, or auto alert options.
8. In Part IV - Payment Method, indicate your preferred payment method for the Lifeline service, and inform if you have any coupons for special rates.
9. Part V - Other Important Information requires details about your landline phone service, any pets you have, and other relevant security information. Ensure to clarify whether you smoke and the habits related to it.
10. Review all the information for accuracy, then save your changes, download, print, or share the completed form.

Complete your SUBSCRIBER PERSONAL INFORMATION form online today for efficient processing!