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Ambulance Service: Winsted Area Ambulance Association

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What's on your bill

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*Please type in the Call/Patient ID # found on YOUR form

type of service
*What type of service did you receive?
9-1-1 emergency service
9-1-1 service but I was injured on the job
9-1-1 service but I was injured in a motor vehicle accident
Routine scheduled transportation

*Date of Service:


patient information

* First Name:     Middle:
* Last Name:  
* Gender:   M   F
* Mailing Address:  
* City:  
* State:    * Zip:
* Date of Birth:  
* Social Sec. #:  
* Home Phone:  
Work Phone:  
* Email Address:  
 
your options

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