Personal Emergency Response System (PERS) Providers Application & Forms


Click on the links below to print or read the applications/forms.

Military Service Member, Veteran, or Military Spouse Supplemental Form

Registration Application/Renewal Form

License Application/Renewal Form

Insurance Certificate Form

Branch Office License Application/Renewal Form

To access documents in Adobe Acrobat format, you must download the Acrobat Reader software. Please see the DSHS file viewing page for more information and a link to the Adobe website.

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Last updated February 24, 2015
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    Board of Examiners for Personal Emergency Response System (PERS) Providers