To set up a safety consultation, please provide some basic information to let us know how best to contact you and to understand your safety goals. We will be in touch right away -- typically within an hour or two.

All information is optional, but the more you provide, the faster and more specifically we can assist you. The information you provide is kept strictly confidential and is never shared. If you wish to talk with us immediately, we welcome you to call the number at the top of your screen.

Your Contact Information
First Name
Last Name
Cell Number
Home Number
Work Number
Email
Should we list you as: Mother    Father    Grandmother    Grandfather    Caregiver    Other


Should We List a Second Contact Person?
First Name
Last Name
Cell Number
Home Number   Same as above
Work Number
Email
Should we list him/her as: Mother    Father    Grandmother    Grandfather    Caregiver    Other


Which of You Should We List As The Primary Contact?
You    Second Contact Person


What Is the Property Address You Are Calling About?
Address Line 1
Address Line 2
City
State
Zip Code


Which of the following safety topics would you like help with?
Child Safety
Home Fire Safety
First Aid / CPR
Emergency/Disaster Planning
Home Security
Home Environmental Issues ( Mold / Radon / Water Safety / Chemical Safety / Air Quality / etc.)
Senior Adult Safety


Is there anything in particular you are concerned about?


If you like, you may send us pictures of key safety issues to review:
Image 1:
Image 2:
Image 3:
Image 4:
Image 5:
Image 6:
Image 7:
Image 8:


If we'll be talking with you about child safety issues, please provide a bit of basic
information about the children in your home:
Boy / Girl Years / Months First Name (optional)
/
/
/
/
/


Directions to Our Home from I-75 North:
(in case home is difficult to locate via GPS)


What would be good days and times for one of our consultants to visit?


How did you hear about PrepareFirst?
Referred by a friend
Referred by a physician
Advertisement in
Internet search
Attended presentation at
Other


Thank you very much for this information!

You will be hearing from us again shortly, typically within an hour or two.

If you click "SUBMIT" and do not immediately receive a confirmation page please call or email us.

  

  

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© 2012-2014 Prepare First. All rights reserved.

Serving: Buckhead, Hapeville, Braselton, Chamblee, Dallas, Douglasville, Milton, Fairburn, Palmetto, Conyers, Covington, Flowery Branch, Buford, Gainesville, Commerce, Athens, Alpharetta, Ansley Park, Atlanta, Acworth, Austell, Avondale Estates, Belvedere Park, Berkeley Lake, Brookhaven, Candler-McAfee, Candler Park, Canton, Carollton, Cartersville, Chamblee, Chastain Park, College Park, Cumberland, Cumming, Decatur, Douglasville, Doraville, Duluth, Dunwoody, Druid Hills, East Cobb, East Point, Ellenwood, Forest Park, Griffin, Johns Creek, Kennesaw, Lake View Estates, Lawrenceville, Lilburn, Lithonia, Mabelton, Marietta, McDonough, Midtown, Metro Atlanta, Mountain Park, Newnan, Norcross, North Atlanta, North Decatur, North Druid Hills, Peachtree City, Perimeter Center, Powder Springs, Redan, Riverdale, Riverside, Roswell, Sandy Springs, Smyrna, Snellville, Stone Mountain, Sugar Hill, Suwanee, Tucker, Union City, Vinings, West Cobb, Woodstock