STAT Emergency Medical Service

Schedule Non-Emergency Services
Schedule your non-emergency transport ambulance or wheelchair services by filling out the form below.

Person Requesting Services:
Contact Phone:
Contact Fax:
E-Mail:
Patient First Name:
Patient Last Name:
Patient Date of Birth:
Pick Up Location:
Pick Up Time:
Destination Location:
Destination Time:
Date of Appointment:
Ambulance or Wheelchair:	Ambulance Wheelchair
Is the patient in your PPS stay?	Yes No
Primary Insurance Carrier:
Policy/ID Number:
Group Number:
Subscriber Name:
Subscriber Date of Birth:

Physician Certified Statements

Click here for your Physician Certified Statement (Non-Emergency ambulance only).

PCS forms are required for all non-emergent ambulance transportation. If you cannot print this form we are able to fax you the form at your convenience.

If you are unable to complete any field on this form indicate N/A and a patient support representative will follow up with you.

If your need is sooner than 24 hours in advance, please contact us @ 810.233.4400 and a patient support representative will assist you immediately.

A STAT EMS Patient Services representative will contact you shortly to confirm your on-line scheduled appointment.

Hear what some of our customers are saying about STAT EMS!

*Pam Dycus, PA for Evergreen Health Care says,

"STAT EMS is very professional and courteous".

*Charlene, Davison DaVita says,

"Loves STAT. We are the BEST company to work with".

*Christian, Fenton DaVita says,

"All STAT crews are professional and friendly"