Aetna EMS Crew Request Form
Please use this form to request an EMS standby for an event. You may either request an ambulance, bike team or both. A representative from Aetna's EMS division will contact you as soon as possible.

Please note there is a $100 an hour charge for a committed ambulance or bike team.

Name
Your answer
Organization
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Email Address
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Phone Number
Your answer
Date of Event
Your answer
Time of Event:
Your answer
Expected Duration:
Your answer
Standby Type
Please note there is a $100 an hour charge for a committed ambulance, gator crew or bike team.
Required
Additional Information
Your answer
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