First Responder Form

First Responder Form

Please note that all responses are kept strictly confidential and will not be shared outside of Health Choice Maine‚Äôs 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.

What was (or is) your relationship to this EMS Organization?
Did you have an employment contract?
What position(s) did you hold with this EMS organization in 2021 and/or 2022? (Check all that apply)
If your association with this EMS organization has ended, how did it end?
If your association with this EMS organization has ended, was the Covid-19 vaccine rule change a factor in your departure?
If you are still with this EMS organization, what steps did you take to stay?

Contact Information

Name
Name
First
Last
Would you like to join our mailing list and be kept up-to-date on our efforts to end the mandate?
Is it OK for Health Choice Maine to contact you if we have further questions?
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