Get Tri-county Firemed Application

Filling out the Tri-County Firemed Application online is a crucial step towards securing emergency ambulance membership for you and your family. This guide provides clear, step-by-step instructions to ensure you complete the process smoothly and accurately.

Follow the steps to complete your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of application in the designated field. This helps in processing your application correctly.
3. Fill in your last name and telephone number as requested. Ensure the phone number is one where you can be easily reached.
4. Provide your street address and apartment number, if applicable. It is important to enter the correct city, state, and zip code to avoid any issues with correspondence.
5. If your mailing address differs from your street address, fill out the separate section for mailing address, clearly indicating the city, state, and zip code.
6. Indicate whether this application is a new membership or a renewal by checking the appropriate box.
7. List all household members. For each individual, provide their last name (if different from the head of household), first name, middle initial, gender, relationship to the head of household, and date of birth.
8. Answer the insurance questions by checking ‘yes’ or ‘no’ for each member regarding Medicare, additional medical insurance, or Medi-Cal.
9. Indicate how you heard about FireMed by checking the relevant box or writing in your source.
10. Read the FireMed agreement carefully. After understanding the terms, sign the application in the space provided for the head of household and any other eligible family members aged 18 or older.
11. Finally, make sure to attach the required payment, either by check, money order, or cash, as specified, and send the completed application before the deadline of October 31st.

Complete your Tri-County Firemed Application online today to ensure prompt access to emergency ambulance services.