Forms & Links

  • If you or a family member have received a communication that we need a signature to bill your insurance, please use the appropriate link below to submit a completed signature form.

    If you are the patient and need to submit a completed signature form, please use this form: CLICK HERE

    If you are completing the signature form on behalf of someone else, please use this form: CLICK HERE

  • If your transport is related to a Motor Vehicle Accident. We are unable to bill your insurance without first billing your auto policy. Please CLICK HERE to submit your motor vehicle information.

  • At the time of your transport, we were unable to obtain your correct insurance and residential information. Please CLICK HERE to submit your information.

  • If you are a facility, you can submit the requested Physician Certificate Statement CLICK HERE.

  • Patients, family, or legal guardians who require copies of medical records may use the link below to request a copy: CLICK HERE

    Law firms requesting medical records: Please CLICK HERE

    Note: This form contains a credit card authorization form. You must submit payment with a completed form in order for us to process your request.

  • If you feel you are owed a refund, please CLICK HERE.

  • If you were billed incorrectly and would like to dispute your bill, please CLICK HERE.

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