Record Request & Forms Library

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APPEAL AUTHORIZATION FORMS

As your advocate, we’d like to assist in the appeal process by submitting an appeal to your insurance. An insurance company may require a signed Designation of Authorized Representative (DOR) Form to be included with the appeal. This form allows Air Methods to represent the patient or policy holder in the appeal process. Please contact our patient advocates at 855-896-9067 to determine which form is required for your insurance.

GENERIC FORMS

Other Forms Library

  • A103 - Financial Assistance Application
    This form is used to apply for financial assistance beyond what has been offered by our patient financial counselors. Financial documentation will be requested.

Records Request Forms

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Patient Advocates
Are Here To Help

855-896-9067

6 am – 4:30 pm PT

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patientforms@airmethods.com

OR

Patient Billing Services
P.O. Box 2532
Fontana, CA 92334-9938

Need Assistance?
Call 855-896-9067