Contact Us at STAT EMS

Schedule Services

Person Requesting Services:
Contact Phone:
Contact Fax:
E-Mail:
Patient First Name:
Patient Last Name:
Patient Date of Birth:
Pick Up Location:
Pick Up Time:
Destination Location:
Destination Time:
Date of Appointment:
Ambulance or Wheelchair:	Ambulance Wheelchair
Is the patient in your PPS stay?	Yes No
Primary Insurance Carrier:
Policy/ID Number:
Group Number:
Subscriber Name:
Subscriber Date of Birth:

	A STAT EMS Patient Services representative will contact you shortly to confirm your appointment. If your need is sooner than 24 hours in advance, please contact us @ 810.233.4400 and a support representative will assist you immediately.