Register to Order

Thank you for your interest in purchasing the revolutionary smartbelt that protects hips and encourages safer mobility.

SENIOR CARE PROVIDERS: We are now accepting orders for senior care providers on a first-come, first-served basis, with a minimum order quantity of 10.  Filling out the below does not obligate you to purchase the smartbelt, nor does it constitute a contract between you and ActiveProtective.  The smartbelt is offered as a monthly subscription or as an upfront purchase (pricing established based on care setting and product features).

INDIVIDUALS: Please use the form below to register to preorder the smartbelt.  Smartbelts will be provided on a first-come, first-served basis.  Filling out the form below does not obligate you to purchase the smartbelt, nor does it constitute a contract between you and ActiveProtective.  The smartbelt will be offered as a monthly subscription or as an upfront purchase (pricing and delivery to be established).

(Items with an asterisk are required)