Request an Ambulance – GREAT BROOK

Emergency Requests

For emergency requests DO NOT utilize the form below. Please contact our communications dispatch center at 603-945-4511

For all other requests or to schedule a non-emergency transport or to obtain a quote for EMS Event Stand-by coverage for your organization you may utilize the form below to contact our administration. We will process your request and contact you.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

AMBULANCE REQUEST INFORMATION

Date / Time that Ambulance is Requested

Date

Time

Address that Ambulance is Requested to

Address Line 1

Address Line 2

City

State

Zip Code

Reason for Ambulance Request

Please describe your request or provide special instructions