Subscription Form


Please Note:


Uninsured parties are not eligible for our subscription program. FCEMS will waive up to 50% of the total bill applied to deductible(s) or total denial(s). Medicare denials are the responsibility of the patient.


Sorry, no refunds or subscription transfers.


We are solely a 24-hour 911 service.


We transport to the nearest, most appropriate hospital.


All patients will be responsible for a minimum charge of $95.00 for refusal of transport. Nursing home residents must have a separate subscription even if a spouse lives in the family home.



First Capital EMS Subscriptions Form

Valid July 1, 2024 to June 30, 2025

Every household member, including yourself, must be entered to be covered.

Household members must live in the home.

You must include both Name and Date of Birth!

 

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