The medic alert pendantís come in luxurious high fashion style designs and are mad in sterling silver and 14kt-18kt white and yellow solid gold metals. All of the finer medical alert pendants are available with three styles of caduceusís and with Diamonds and Rubies All medical alert pendants are sold with chain separate unless otherwise stated. Gold and silver chains are available separately and come in all sizes ant thickness. Medical Alert pendants come with lifetime warranty .All Medical Alert pendants come with free engraving. Our medical alert Pendants are designed to look like fine jewelry yet alert paramedics or other officials of your medical condition. All of medical alert pendants are manufactured to highest standards so as to last for many years to come that is why we can give a lifetime warrantee. Our warrantee covers, brakeage, refinishing to look like new, free engraving for the lifetime of medical alert bracelet should your medical condition change. The only thing Warrantee does not cover for loss or shipping.. We do not use red enamel in the medical caduceus as it only comes out after a short time. All medical alert pendants are hand crafted and engraved to order. Medical alert Pendants come in sizes from about the size of a dime to quarter size.