EMS Billing Information Update Form

////EMS Billing Information Update Form
EMS Billing Information Update Form2016-08-18T17:06:34+00:00

This secure on-line form is designed to provide us insurance information that was not available at the time of care.  You do not need to complete every field listed below, only those relevant to your situation.  Our staff are specifically trained to file your medical bill with your insurance provider, Medicare, Medicaid, MAP, Workers Compensation or auto insurance, so you can focus on a speedy recovery.  If we can be of further assistance or answer any questions regarding your bill or your medical care please contact us at 409-880-3148.

Patient Information
Patient Insurance Information
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