Please Provide Insurance Information

Please Provide Insurance Information
 
Physicians Ambulance Service, Inc.
4495 Cranwood Parkway,
Cleveland, OH 44128-4003
http://www.physiciansambulance.com
 
If we have not been provided any insurance information for a patient, a bill can become the patient's responsibility!
 
Please fill out and return this form, so we may bill the patient's insurance in a timely manner, and avoid patient responsibility. Please submit this form or call our Patient Accounting Office at 216-823-2100.

Patient Information

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Do you have insurance? *

Insurance Information

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