Insurance Information

The form below will allow you to submit insurance information for your ambulance transport directly to our billing department.

Please provide us with the necessary information to file a claim in the section below. If your injury was due to an automobile accident, we need both automobile insurance and health insurance information.

If you have any questions, feel free to call us at (256) 261-9184 for assistance.

  • Date of Transport

  • Auto Insurance Company

  • Health Insurance Company

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