Provide Insurance Information

Please complete this form in order that we may process payment through your insurance carrier and/or Medicare.

Please note that coverage of ambulance transportation by insurance carriers may vary materially based upon a patient’s individual policy.

Please check with your carrier to verify your coverage.


Patient Accounts

Insurance Information

    Patient Information

  • Billing Information

  • Primary Insurance

  • Secondary Insurance




Erickson AmbulanceProvide Insurance Information