Please answer the questions below and hit submit when finished (we take data protection seriously; click here to learn more).
Note that only sections labeled with a
red “ *” are required information to submit this form.
If you have any questions during this process, please don’t hesitate to call us at 888-343-1513 and push option 1 for our Customer Success Team.
Your Kanega Watch will ship within one business day of us receiving this completed form.
We look forward to meeting you during your on-boarding call (see below). ☺
Wearer Information The person who will be wearing the Kanega Watch is... * Myself Someone else - as specified below Buyer's Email
Wearer's First Name * Wearer's Last Name * Wearer's Address - Street Address * Wearer's Address - City * Wearer's Address - State * Wearer's Address - Zip Code * Does the wearer's residence have a gate code? * No Yes Wearer's gate code Does the wearer's residence have a lockbox? * No Yes Wearer's lockbox code Is there a hidden key location? Or is the lockbox location not obvious? * No Yes Hidden key/lockbox location Wearer's Email
Primary Phone - Can you receive text messages on this phone? * Yes No Wearer's primary phone number Wearer's mobile phone number - Mobile Wearer's secondary phone number Can you receive text messages on this phone? Yes No Wearer's Date of Birth: *
MM slash DD slash YYYY
Hidden Year of Birth Wearer's Gender: * Female Male Wearer’s Watch Size * Small (minimum 5-1/4" wrist circumference) Medium (minimum 5-3/4" wrist circumference) Large (minimum 6-3/4" wrist circumference) X-Large (minimum 7" wrist circumference) (OPTIONAL) If you wish, you can provide information for the medical alert operators to pass along to emergency responders if they are activated. For example: drug or other allergies; chronic diseases; or specialized instructions ("No blood pressure or needles left arm"). Wi-Fi Configuration Find the name and password for the Wi-Fi network in your residence. The name is also called the “SSID”. If your Wi-Fi Network has a separate name (SSID) for 2.4 and 5GHz (likely printed on a sticker on your router), please provide the 2.4 GHz credentials.
Sometimes, this name is a sequence of random numbers and letters, and people sometimes personalize the name of a Wi-Fi network to help users identify its owners (i.e. "The Smith Family WiFi").
Wi-Fi networks are protected by a password for security. Please provide the password so the Kanega Watch can access your Wi-Fi network.
Important: The Wi-FI password is case sensitive. It is important that the network name and password are entered accurately. Primary Wi-Fi Network Name (SSID) * Primary Wi-Fi Password: * Secondary Wi-Fi Network Name (SSID):
If you have a second Wi-Fi (like work or another dwelling), please include.
Secondary Wi-Fi Password: Emergency Contact Information Please enter the contact information of the responsible parties in the order that they will be contacted in case of emergency.
You may include up to three contacts. At least one emergency contact is required. Emergency Contact #1: First Name * Last Name * Hidden Name _Hidden
Emergency Contact #1 Email
Primary phone number * Can you receive text messages on this phone? * Yes No Secondary phone number Can you receive text messages on this phone? Yes No Relationship to wearer * Spouse Son / Daughter Friend Neighbor Relative Other relationship Emergency Contact #2: Emergency Contact #2 - First Name Emergency Contact #2 - Last Name Emergency Contact #2 Email
Primary phone number Can you receive text messages on this phone? Yes No Secondary phone number Can you receive text messages on this phone? Yes No Relationship to wearer Spouse Son / Daughter Friend Neighbor Relative Other relationship Emergency Contact #3: Emergency Contact #3 - First Name Emergency Contact #3 - Last Name Emergency Contact #3 Email
Primary phone number Can you receive text messages on this phone? Yes No Secondary phone number Can you receive text messages on this phone? Yes No Relationship to wearer Spouse Son / Daughter Friend Neighbor Relative Other relationship Onboarding For the best wearer experience and understanding of the watch’s functionality, we recommend wearers have a brief personalized call with one of UnaliWear’s Customer Success team members. Once your watch ships, we will contact you to schedule this call, unless you check the box below. Hidden Onboarding - Opt Out Opt Out Hidden Onboarding - Pending Pending Preference for contact (select all that apply): Phone call Video call Text Email Medication Reminders Never forget to take your medications and pills again! The Kanega Watch medication reminders are customizable and easy to understand.
If you'd like for us to set up your medication reminder times for you before we ship your watch, just set them up here.
You can always set up, change, or remove your medication reminders from the Kanega Wearer Portal after you've received your Kanega Watch. Would you like for us to program your medication reminder times for you right now? * No Yes How many medication reminder times will you need? (Up to 5 times) One (1) medication reminder time Two (2) medication reminder times Three (3) medication reminder times Four (4) medication reminder times Five (5) medication reminder times First medication reminder time: Second medication reminder time: Third medication reminder time: Fourth medication reminder time: Fifth medication reminder time: Customization of Alert Sensitivities Kanega Watches have two ways to get help from our 24/7 monitoring center without having to push an alert button: Fall Detection and Voice Activation.
Some alerts can happen, even when the wearer does not need help. We recommend new wearers wear their Kanega Watch for a few days to determine how often these false alerts are occurring.
Sometimes our default setting is too sensitive or not sensitive enough depending upon your needs or lifestyle (eg: highly active wearers may benefit from a reduced fall detection sensitivity). Changing the sensitivity is as easy as calling us, since we can remotely adjust the sensitivity of your watch’s alerts. We can even turn off certain features for those wearers who may find some types of alerts confusing and/or overwhelming.
The key is ensuring all wearers are comfortable and confident wearing their Kanega Watch regularly — providing real peace of mind for each wearer and their loved ones.
We look forward to you having a great experience with your Kanega Watch.