MedicaReemo Wellness Watch Order Form Need help? medica@reemohealth.com 1-844-737-0685 REEMO WELLNESS WATCH PACKAGE Medica - Activity Tracker WHO IS THIS WATCH FOR? (Member Information) * Please Complete Watch Recipient First Name Last Name Member Phone * (###) ### #### Date of Birth * MM DD YYYY Medica ID * Wearer Email * Email is used for shipping information and access to the online portal. The online user portal displays activity history (Steps, heart rate) and watch status. Primary Language (if not English) Physical Address (no PO Box) * Address 1 Address 2 City State/Province Zip/Postal Code Country Is Shipping Address same as Physical Address? Yes No - please enter below Would you like to receive Medication Reminders? * Yes No Would you like to set up 1-Touch Calling? * Add a caregiver to call with one touch of your watch. Yes No Choose Personalized Messaging Packages (up to 3) Daily Stretch Daily Inspiration Daily Riddle Daily Devotion (Christian) Weekly Reducing Isolation Weekly Healthy Eating Weekly Active Living Weekly Mental Health Check-in Weekly Laughter is the Best Medicine Message How did you hear about us? Thank you!
