Event Medical Services
Coverage Request Form
  • Please complete the form below as accurately as possible, and we will be more then happy to provide you with a quotation for services. We appreciate at least 14 days before your event to provide you with the quotation, however we will do our best to provide a quotation and service on shorter notice if possible.
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  • Please upload the following if Available:

  • Thank you for your request. An event medical services specialist will review your request, complete an event risk analysis, and provide a quotation for coverage with recommended staffing within 48 hours.

    Please note that by completing this form, this does not confirm acceptance of your event. A course agreement will be drafted after acceptance of the quotation.