Form Center

2. Texas State Law

   Texas State Law requires that automated external defibrillators (AED's) be registered with local emergency medical services providers.  To confirm your existing or new AED is registered, please provide the requested information.  By providing us with this information, we can work together to make a difference when seconds count.

4. Company/Organization
6. Address
7. City
8. Zip Code
10. Contact Person
11. Phone Number
12. Email Address
14. AED Type
16. AED Location

    (IE: Break room in Suite Number; in Security Office, First Floor Main Lobby)

18. Uploaded to Pulse Point App

    1. yes
    2. no

    Find out more at www.pulsepoint.org

20. Section 779.005

    Notifying Local Emergency Medical Service Provider. When a person or entity acquires an automated external defibrillator, the person or entity shall notify the local emergency medical services provider of the existence, location, and type of automated external defibrillator.  

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field