Reemo

Current Reemo User Info: *

Please Complete Watch Recipient / Participant

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Would you like to enroll in or change Medication Reminders? *

Yes

No

Would you like to set up 1-Touch Caregiver Calling on your watch? *

Creates screen for one-touch call to desired contact.

Yes, set up "Call my Caregiver" (personal contact)

No, I do not wish to set up 1-touch calling

Would you like to sign up for daily or weekly Personalized Messaging Journey? *

Simple messages to remind, inspire, or motivate the user.

Yes

No

Submitted by: *

Member

Care Coordinator / Case Manager

Reemo Support