Rockford Main Office
Call (616) 866-0724
Sign up for the Rockford Ambulance Care Plan right here online.
Or download a printed form from the link at right.
Family Member Information
Names of Covered Members Living in the Household
(Please fill in information for EACH Covered Member)
It's easy to sign up for the Rockford Ambulance Care Plan... just fill out our online form.
If you'd rather download a printed form, get it at the link below. Then mail it to us or drop it by our offices.
Download PDF File:
Care Plan Membership Application Form
Rockford Ambulance offers an annual membership program called the Care Plan to the residents in our service area.
For only $39 per year, you and your family will be covered from any out of pocket expenses incurred from medically necessary ambulance transports to and from the hospital.
Health care costs continue to rise at alarming rates along with increased co-pays and deductibles. Joining the Care Plan will eliminate out of pocket expenses for medically necessary ambulance transports.
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Use our online payment service to securely and conveniently pay an ambulance or wheelchair van bill, or to make a donation.
We offer an annual membership program called the Care Plan to residents in our service area. $39 per year covers out-of-pocket expenses for medically necessary ambulance transports to and from the hospital.
We serve Rockford, Cedar Springs, Lowell, Sparta, Sand Lake, Belmont, Kent City, Algoma, Alpine, Cannon, Courtland, Grand Rapids Charter, Grattan, Lowell, Nelson, Oakfield, Plainfield, Solon, Sparta, Spencer, Tyrone, Vergennes and Chester.
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