In order to complete your enrollment form, all required fields must be completed.

Only individuals with Alzheimer's or related dementia living in Manhattan, Brooklyn, Bronx, Queens, or Staten Island are eligible for MedicAlert® NYC Wanderer's Safety Program.

Please use the back button on this form if you need to go back to previous steps (do not use your browser's back button)

*To update any changes to your enrollment (e.g. address, primary contacts, medication, etc), please call MedicAlert® 800-432-5378.