Support Program Enrollment

Enroll today for free support and services!

You are urged to enroll in the Philips HeartStart Support Program. This allows Philips or the FDA to send you important notifications about the product. Your participation also allows us to contact you and learn more about home defibrillation. You can also choose to get accessory reminders and other special services.

For these same reasons, we ask you to contact Philips if you move or if you sell, give away, or throw away your HeartStart.

To thank you for enrolling, we'll send you a Fast Response Kit for free.

It takes only a few minutes to enroll. Select the way most convenient for you: (1) Complete the form below, or (2) Fill out the card that came with your HeartStart and mail it in, or (3) Call us at 1.866.DEFIBHOME (1.866.333.4246).

Your information will be kept confidential.

Thank you for joining the Philips HeartStart Support Program.

* Indicates required field.

PERSONAL INFORMATION

* First Name
*Last Name
*Address
Address 2
*City
*County
*Post/Zip
*Telephone
*Email

QUESTIONS

1. Your education level
Less than High School
High School
College
Graduate school

2. Year of Birth

* 3. HeartStart Serial Number (located on the back of the defibrillator)

* 4. Where Purchased

5. If other or if from authorized reseller or distributor, please specify

* 6. Date of Purchase (mm/dd/yy)

7. If other, please specify

8. Primary motivation for buying the HeartStart Home Defibrillator

9. If other, please specify

10. FREE SERVICES (check all that apply)
Please send reminders about battery and pads replacement.
Please send updates about home defibrillation

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