Medical Alert Southwest

PERS Call List



2651 Sagebrush Dr. #104
Flower Mound, Texas 75028

(972) 355-0086





  1. PRIMARY RESPONDER DISCLOSURE: Subscriber understands that a (1) 911 center, (2) public safety answering point, or (3) communications center, (Collectively referred to herein as “PUBLIC RESPONDERS”), may be designated as the primary responder.  Subscriber assumes all liability should one of these three not be selected as the Primary responder.                                                


  1. 2. Upon MEDICAL ALERT SOUTHWEST (hereinafter referred to as “MAS” or “ALARM COMPANY”) receiving an emergency alarm from the Subscriber’s system, Subscriber hereby directs MAS to contact the below listed first responders in the order specified in the list. (See AUTHORIZED INDIVIDUALS TO BE NOTIFIED section below.)



  1. Upon MAS receiving an emergency alarm from the Subscriber, Subscriber
    direct MAS to attempt to contact Subscriber first before contacting any responders.


  1. Subscriber agrees that should any PUBLIC RESPONDER not be designated as the primary responder, then the Subscriber’s PUBLIC RESPONDERS shall become the default secondary responder after the personal emergency response provider has attempted, without success, to notify all other responders designated by Subscriber.


  1. Should MAS receive a customer’s alarm and is not able to solicit a verbal response from the Subscriber, Subscriber
    wish to have a PUBLIC RESPONDER contacted before MAS contacts the customer’s responders as specifically designated above.


  1. MAS hereby agrees to provide PUBLIC RESPONDERS, if designated as a responder by the Subscriber, the name of the customer, the location from which the customer’s alarm was received, and any other information as may be requested..


  1. Following any notification to the PUBLIC RESPONDER, MAS shall attempt to notify others on the Subscriber’s list in the order provided by Subscriber.  Unless otherwise provided in the list MAS will make a reasonable effort to contact the first person reached or notified on the list either via telephone call, text or email message.  No more than one call to the list shall be required and any form of notification provided for herein, including leaving a message on an answering machine, shall be deemed reasonable compliance with MAS’ notification obligation.  Subscriber may provide MAS with a set of directives for voice to voice contact with the responders.  For nonpublic responder numbers Subscriber represents that all call numbers are accurate and Subscriber has been authorized by the owners of such numbers to provide such numbers to be called in accordance with Subscriber’s alarm services.


(Individuals to be notified in the event of an alarm condition.)  


            Subscriber may select any individual he or she designates, or any PUBLIC RESPONDER in the Jurisdiction from which alarm is received.


                                        NAME                                                          PHONE NUMBER

                              FIRST RESPONDER                                         















In case of extreme emergency, I hereby authorize any licensed Physician to administer all emergency medical treatment deemed necessary (all adult family members must sign for themselves; responsible adults must sign for minors 18 years old and younger):



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Signature Certificate
Document name: PERS Call List
lock iconUnique Document ID: fe114a5b06489b28959b5955977b7c7bea5168a1
Timestamp Audit
January 3, 2020 10:45 am CDTPERS Call List Uploaded by Esig Admin - IP