Please Supply the Following Information for Your Analysis

Download fillable PDF Here

FEASIBILITY ANALYSIS FOR
AMBULANCE MEMBERSHIP
REVENUE PROGRAMS

PO Box 22008
Eugene, OR 97402

phone: 541-687-1214
toll free: 1-800-543-9062
fax: 541-484-1007
jp@firemed.com

Public & Private Program Development

  1. Current System Revenue Profile
  2. Current System Demographics

    Approval signature & date

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FEASIBILITY ANALYSIS FOR
AMBULANCE MEMBERSHIP
REVENUE PROGRAMS

  1. Initial information that MUST be provided in order to evaluate effective strategies







      1.  Yes   No  
      2. Yes No  
  2. If you have chosen to fill the downloadable PDF version, please submit to jp@firemed.com | fax: 541-484-1007

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