Common Forms

Assignment of Benefits (119.18 KB)
Authorization Signature Form (46.5 KB)
Comment/Complaint Form (141.5 KB)
Facility Guarantee of Payment (44.65 KB)
Medicaid PAN form (34.87 KB)
Non-Emergency Transportation Agreement (38 KB)
Physicians Certification for Ambulance Service (21.25 KB)

Return signed forms to:

Area Metropolitan
Ambulance Authority
551 E. Berry St.
Fort Worth, TX 76110-4329

(817) 632-0537 (FAX)