USA & Canada: +1-800-872-6667

International: +1-832-872-2222

THANK YOU FOR YOUR SUBMISSION

Dear Kelvin thank you for your submission.

Download the Ground Ambulance Provider Agreement Form below. Once you complete it and save it, please email it to 

Please fill in additional rate sheets as needed if different rates are applicable per each location. Once you complete it and save it, please email it to , attaching your current liability insurance certificate. For US Providers, please include a copy of your current W9, and for the overseas providers, attach a current copy of your service permit license certificate.

If you have any questions, feel free to reach us directly or contact our provider’s department, as shown on this page.

CONTACT INFORMATION

OUR CUSTOMERS INCLUDE

  • Private pay individuals & institutions
  • Hospitals, medical centers
  • Rehabilitation centers
  • Worker’s compensation management companies
  • International liaisons and medical concierges
  • International travel insurance agencies
  • Embassies and consulates
  • Repatriation organizations
  • International medical assistance organizations
  • Medical tourism & travel assistance
  • Healthcare provider industries
  • Organ procurement organizations
  • Hospital social workers
  • Discharge planners and case managers

COVERAGE

  • United States
  • Canada
  • Mexico
  • Central America
  • The Caribbeans
  • Latin America
  • Western Europe
  • Asia
  • Middle East
  • Australia
  • Africa
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