BoundaryCare Configuration Form
This form is for the use of approved vendors/providers who are specifying the configuration for a BoundaryCare equipment package. Data provided will not be shared or used for any purposes other than for processing this order request. When completed, send this form to sales@boundarycare.com. We’ll contact you if further information is required.

Alternately, you can download the fillable PDF of the same form here, filling it out electronically, or even by printing it out and completing it by hand.

Your order will be placed once we have received your configuration information and, separately, your payment information. This form is secure. Data provided will not be shared or used for any purposes other than for processing this order request.

Estimated time of completion of all sections is 8 minutes.

This is section 1 of 4.
Provide the contact email address for the person submitting this form:

PART I: PRIMARY USE(S) FOR THIS DEVICE

PART II: EQUIPMENT
Equipment type *
Wrist Preference *
The wrist the client will wear the Watch on. Default is Left.
Apple Watch Case & Band Color *
The Apple Watch comes with a thin protective case and a matching band. The default case & band color is Black.
Band Options *
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