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Forms

Patient authority for the release of information
This form authorises SA Ambulance Service to release information relating to an ambulance invoice to a nominated third party

Member authority form
The member authority form will provide authority for someone other than the primary member to make changes to the nominate Ambulance Cover subscription.

Change to Ambulance Cover membership details
This form can be used to request a change of address or member name on a nominated ambulance subscription. A change of name request must be accompanied by copies of relevant legal documents.
 

  
Creative Commons License

The content on this page is licensed under a Creative Commons Attribution 2.5 Australia Licence, unless indicated otherwise.
To attribute this material, cite SA Ambulance Service, 2012.