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Ambulance Subscription
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Head of Household - Contact Information
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Family Members
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Step One
This subscription service is not available to medicaid clients, apartment buildings or tenants not on a utility bill.
The Colony Fire Department charges The Colony resident $800 for Basic Life Support and $900 for Advanced Life Support. In addition, a fee of $7.00 per mile is charged from the incident location to the nearest medical facility that is able to care for the patient appropriately. An itemized breakdown of medical supplies is also incurred while under the care of the EMS personnel.
The Colony offers an alternative program for those interested in managing their costs with more certainty. The Colony citizens can subscribe to an Ambulance Subscription Program. For $8.00 a month added to your city utility bill, subscribers are entitled to three emergency transports per year without any out-of-pocket expenses. However, insurance companies will be billed. This benefit is only available to residents of The Colony. The resident may cancel this service in writing at anytime. The Colony EMS may terminate an existing membership for any reason by giving 30 days written notice to the subscriber.
If protocol recommends CareFlite, this subscription service does not apply to the services provided by CareFlite.
In the event emergency transport cannot be provided by The Colony Fire Department, the mutual aid plan will be activated. The emergency service providing the mutual aid will transport the patient and bill the patient. It is the responsibility of the patient to submit the bill to The Colony Fire Department for payment processing.
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Head of Household - Contact Information
First Name
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Middle Name
Last Name
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Address
*
City
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State
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Zip Code
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Phone Number
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Account Number
*
Please provide the account number off of your current water bill.
Email Address
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Family Members
Family Members (Name, Relationship, Birthday (MM/DD/YYYY)
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Please provide the names, relationship and birthday of each family member.
Enrollment Options
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I have read and am aware of the purpose, rules and benefits afforded to me and my family members listed above in return for having joined The Colony EMS Subscription Program, and do hereby agree to all provisions as stated.
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