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Home
Services
Transfers
Billing
Privacy
Training and CPR
Ride Along Program
Employment
Information
About
Contact
Ambulance service questionnaire
*
Indicates required field
Ambulance Service Name
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City of Operation
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Staffing (check all that apply)
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Full-time
Part-time paid
Volunteer paid
Volunteer unpaid
Other
Provider level of staff on roster (check all that apply)
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Paramedic
Advanced EMT
EMT
EMR
Driver
Provider level with patient during transport
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ALS only
ALS or BLS
BLS only
Service area (check all that apply)
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Within city limits
Rural
Nearby smaller communities
Does your ambulance service receive taxpayer funding?
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Yes, through city goverment
Yes, through county government
Yes, through an ambulance tax district
No
If no taxpayer funding, what is your ambulance service's primary funding source? (optional)
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Does your ambulance service bill for calls?
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Yes, we bill all billable calls
Yes, we bill some billable calls, but not all
No, we do not bill for calls
Billing system:
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In-house
Third-party
Parent company
None
Other
Revenue vs expenses (select one)
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Our ambulance billing revenue meets or exceeds annual budget expenses WITHOUT additional funding
Our ambulance billing revenue meets or exceeds annual budget expenses WITH additional funding
Our ambulance billing revenue does not meet or exceed annual budget expenses
Our ambulance does not have billing revenue
No answer / not applicable
Additional comments (optional):
*
Submit
