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AED registration form

Short URL: kingcounty.gov/aed/registration

Congratulations on acquiring an AED. If you have not yet obtained Medical Direction for the use of your device, you may request it from the Seattle or King County Medical Director, or a licensed physician of your choice.

The next step is to register your AED with King County EMS, completing the form below. When your device is registered, 911 dispatchers can direct callers to the nearest AED in an emergency.

If you have multiple devices, or are making updates or revisions to a currently registered AED, contact Laura Miccile, CPR/PAD Program Manager at 206-477-8664 or laura.miccile@kingcounty.gov, or you may complete and return the Supplemental AED registration form (in Microsoft Excel).

AED CUSTOMER INFORMATION


Mailing address:

Check if this is a private residence.

Business phone with area code:

SITE COORDINATOR INFORMATION

Phone number with area code:

Alternative phone number with area code:

Email

AED INFORMATION


Street address of AED location:

Common name of building/office/location

Placement of AED: Describe the location of the device at this address:

Is the AED accessible to the public?
Yes No

Check here if you do not want your registered AED listed in the Pulse Point app.

Additional comments or instructions:

How did you hear about AED registration requirements?

This website

Traditional media (television, radio, newspaper)

Social media (Facebook, Twitter, YouTube, etc.)

Online search (Google, Bing, Yahoo, etc.)

Word-of-mouth (heard from someone else)

CPR/AED training

AED manufacturer/distributor

Presentation

PulsePoint mobile app

AED PROGRAM MANAGEMENT COMPANY

AED COMPANY MANAGEMENT NAME

TO RECEIVE CONFIRMATION, PLEASE PROVIDE VALID EMAIL ADDRESS

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