Please complete the form below and send it to United Lifeline, and one of our representatives will contact you promptly. Below the form, you may also inquire via our website for more information. During a personal visit, we can determine the best location for the Lifeline unit, explain how it works and answer any questions so our new subscriber is comfortable using it in an emergency. Because there is no long-term contract to sign, you can discontinue service at any time. But we know you will be pleased with our service – we’ve made a real difference for more than 10,000 subscribers and their loved ones since 1983, and we can for you, too.