Current Reemo User Info: *

Please Complete Watch Recipient / Participant

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Case Manager Info: *

Please Complete Watch Recipient / Participant

First Name

Last Name

Would you like to enable the "Call My Caregiver" function?

This allows users to dial a pre-programmed dedicated number through their watch.

Yes

No

Would you like to enable the "Call My Healthplan"?

This allows users to dial a pre-programmed dedicated number directly to their health plan

Yes

No

Would you like to enable the "Call My Care Coordinator" function?

This allows users to dial a pre-programmed dedicated number through their watch to their case manager.

Yes

No

*

I understand and have communicated to the member that Medication Reminder and One-Touch Call functionality will be enabled within a month of request submission and messaging packages will be enabled by 7/1/2025.