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.