Event Medical Cover - Enquiry Form - Primary Ambulance Services

Event Medical Cover - Enquiry Form

Please complete this form as fully as possible for a no-obligation quotation
Organisation / Company Name: *
Main Contact Name: *
Address (Of Organisation/Organiser) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landline/Main Phone Number: *

Area Code Phone Number
Mobile/Direct Phone Number: *

Area Code Phone Number
Contact Email
example@example.com
Is your billing address different from the information above?

Yes No
Billing - Organisation / Company Name:
Billing - Main Contact Name:
Address (For Billing/Invoicing Purposes)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Landline/Main Phone Number:

Area Code Phone Number
Billing Email:
example@example.com
Event Details:
Event Name / Description *
Event Location *
Please be as descriptive as possible, especially if this is an outdoor event, over a wider area.
Medical Cover Start Date and Time: *

Day Month Year
Medical Cover to Start: Hour Minutes
Medical Cover End Date and Time: *

Day Month Year
Medical Cover to Finish: Hour Minutes
For Multiple Days, or Multiple Events, please specify required dates and times here:
Specific Activities Taking Place: *
Event Website (Or Online Location for Further Information): *

Expected Numbers of People Involved: *

Total Max Overall

Max at any One Time

Participants

Spectators

Staff/Volunteers

How will they be accommodated? (Select all that apply) *

Standing Seated
Demographic - Who is the event aimed at? (Please select all that apply) *

General Public (On the Day) Pre Booked/Invited (Ticketed) Guests Only Mainly Children (Under 18's) Mainly Young Adults Mainly Middle Aged Persons Mainly Older Persons Family Groups Groups, But not family.
Are any other organisations involved in the provision of Medical Services to this event? *
If Yes, please describe in detail.
On The Event Day
Who do our team report to on the day? *
What is their contact number? *

Area Code Phone Number
Is there a facility available for treating casualties in private? *
Please provide details, If no facility available, we will need to provide this on your behalf
Is Free Parking available to our team? *

Yes No
Is Fresh Water available to our team? *

Yes No
Please detail the medical resources you feel are required for your event, *
e.g. Number of Ambulances, First Aid Points, Response Vehicles, Paramedics, Technicians, First Aiders etc.. and estimate how many. (Details of what your last Medical Team supplied would be a good starting point).
Please detail any further supporting information: *
This might include previous injury/incident data, details of any additional resources that could be made available to our team etc.
Upload any Supporting Documentation:

Browse Files
e.g. Risk Assessments, Maps, Event Specifications etc. Cancel of
By submitting this form, i understand that i am requesting a quotation for the services of Primary Ambulance Services. I acknowledge that completion of this form does not constitute a firm booking. I have completed this form with the correct information to the best of my knowledge and will undertake to inform Primary Ambulance Services of any changes to the information. I have read and will comply with Primary Ambulance Services standard terms and conditions. I will forward all relevant documentation to Primary Ambulance Services, including risk assessments, site plans and emergency escalation plans. *

I Agree
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Event Medical Cover - Enquiry Form

Event Details:

On The Event Day