If you have any issues, please contact the Decatur Ambulance Business Office at 217-362-5933 Monday-Friday 8am - 4pm

Patient Details

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Last Name:
Call Number:
Date of Service:
Phone Number:
Street Address:
Address Line 2:
City:
State:
Zip Code:
Country:

Billing Details

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Last Name:
Email (for receipt):
Street Address:
Address Line 2:
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Zip Code:
Country:

Amount Due

Credit Card Details

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Credit Card CCV:
Expiration Date: