EmailMe Form - Event Medical Services

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.

Event Name *

Event Type *

Event Location *

Contact Person *

Contact Phone # *

### - ### - ####

Contact Email: *

Date of Event: *

MM / DD / YYYY

Time EMS Service is needed on site: *

HH : MM AM/PM

Estimated End Time of event: *

HH : MM AM/PM

Is your event: *

Indoors

Outdoors

Is there a protected (heated or air conditioned) area for our crew to setup a medical station? *

Yes

No

Is there a designated area for the ambulance to park (if required) *

Yes

No

Is there a power outet within 25m of the ambulance parking or medical station area? *

Yes

No

Approximate Number of Attendees: *

Is alcohol being served at your event? *

Yes

No

Do you have security services booked for your event? *

Yes

No

If yes, please specify the security service

Please upload the following if Available:

Proposed Route Map

Site Map

Event Schedule

Comments and Additional Instructions

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.