Emergency Notification Cards Standard Order Page, Contact, ID, Medical Alert Information

Standard Notification Card
Ordering Page

Enter your Personal Information for your Standard In Case of EMERGENCY Notification Card(s) below.
(The name is the only required information. ALL other fields are optional.)

Name:	Required. As you want it to appear on the card.
Town:	We recommend providing the town.
State:	We recommend providing the state.
Country:	We recommend providing the country.
Month born:	This helps determine further positive identification.
Year born:	(ie. 1964, not birthdate) This helps emergency personnel estimate age.
Organ Donor:	InCaseofEMERGENCY.com encourages the gift of life.
	InCaseofEMERGENCY.com encourages the gift of life.
Language:	Please select the language you speak and best understand.

Enter contact information of up to six people you would like contacted
In Case of an EMERGENCY. (All fields are optional.)

Person to Contact	Telephone	Type	Relation

Enter your Medical Information in the box below. (Optional)

This area is completely optional. It is intended as a brief medical summary of conditions that will not change. You may want to include any allergies, medical conditions and medications you consider important for emergency personnel to be aware of. This area can also be used for additional contact information or information you would like permanently added to the card.
Some example information is listed below.

Diabetic or Asthmatic
Severely allergic to shellfish or penicillin or
peanuts or bee stings. (Anaphylactic shock)
Contact family for Living Will or DNR.
Please contact Dr. Phillip Remmington at
County General Hospital (123) 456-7890.

I have a pacemaker.
Medical condition: I have had a heart attack or stroke.
Maintenance medication(s): 1 mg. xanax.
Bypass surgery performed in July 2009.

Please check your spelling and dosage information for accuracy. The medical information area can accommodate
up to 240 characters including spaces.

characters left.

	Required.	I have confirmed and verified the information entered above to be correct and free from typographical errors. I am aware that any Notification Card printed will only contain information that I supply, and In Case of EMERGENCY.com cannot verify the information is complete, accurate, or correct.
	Required.	I request In Case of EMERGENCY.com to prepare and print a notification card using the information that I supply and am responsible for.
	Required.	I HAVE READ, UNDERSTAND AND ACCEPT ALL POLICIES, TERMS, LIMITATIONS AND CONDITIONS OUTLINED ON THE POLICIES & TERMS PAGE OF THIS WEBSITE, INCLUDING THE LIMITATION OF LIABILITY.

Note: All information provided to In Case of EMERGENCY.com regarding this and all other
sales transactions is treated as privileged and is never used beyond
notification purposes regarding pending sales orders.