Emergency Services Experience Form Emergency Services Experience Form Please note that all responses are kept strictly confidential and will not be shared outside of Health Choice Maine’s leadership and legal team. (If you prefer to answer these questions by phone, you can do so by calling 207-200-8490.) See our Save Maine’s EMS System page to learn more about how we are using these responses. Did you or someone you know need emergency medical services in Maine between August 2021 and the present? * Yes No What type of event caused the need for medical services? * Health emergency Car accident Injury at home Fire Other What was the date of this emergency medical event? * In what town did this medical emergency take place? * Please tell us about the experience and the care that was received: * Contact Information Name * Name First First Last Last Email * Phone Would you like to join our mailing list and be kept up-to-date on our efforts? * Yes No Is it OK for Health Choice Maine to contact you if we have further questions? * Yes No If you are human, leave this field blank. Submit
