Forms and Documents

Paperwork Picture

Below you will find the following documents:

  • Notice of Privacy Practices Form - To inform all who are transported by Milford Ambulance Services about how we protect the patient's privacy while following with HIPPA Standards.
  • Patient Request for Medical Records Form - For those wish to see their medical records on file with Milford Ambulance Service. Please allow 7-10 business days for records to be processed. (Fillable PDF Form)
    • You must also bring a valid physical ID, to prove who you are  (i.e. - Driver's License, State ID, U.S. Passport )
  • Hardship Forms
    • This form is available for those experiencing financial hardships
    • There is fillable form as well as a hard copy (non-fillable copy) available 

Milford Ambulance Service would like to provide printable paperwork items that are commonly asked for to the public to download and complete. Please return the completed forms to Milford Ambulance Service.

Please see the attached forms below:

 

Last Revised on 01/17/2024