Ride Along Requests

Thank you for considering Tri-State Ambulance or Tri-State Regional Ambulance for an ambulance ride along. Please complete the below form to inquire further.

In addition to the below form, all participants in the Ride-Along program need to read and complete the Release Agreement obtained by clicking on the download link. This ensures participants are aware of the risks and the important of patient privacy. Please download the form, complete it, and either attach it at the bottom of the ride along request or bring it with you on the day of your ride along. Thank you!

You must bee at least 16 years old (and have parental permission) to participate in an ambulance ride along.
Please select the company with which you would like to conduct your ride along.
The best e-mail address to contact you.
The best phone number to contact you.
Your home address.
Please enter the phone number of the individual you listed as your emergency point of contact.
What is your relationship to your emergency point of contact?
What is your current job / provider status?
If you selected other, please explain.
Drop your file here or click here to upload.
If you have the TSA / TSRA Release Form completed and would like to attach it to this submission, you can do so here.