Ambulance Report Application

Please note that the field marked is compulsory and click the Continue and Preview button for processing.
This form takes approximately 10 mins to fill.
INCIDENT DETAILS
PATIENT DETAILS
REQUESTOR DETAILS
CONTACT DETAILS

DISCLAIMER: Upon successful payment made via credit card or internet direct debit, a tax invoice/receipt will be sent to the above email address. For payment made via GIRO, a hard copy tax invoice/receipt will be mailed upon successful deduction.

PATIENT'S CONSENT

Written consent must be provided by the patient/patient's next-of kin to allow the requestor to retrieve the ambulance report. In the event of patient who is medically unfit or has passed away, the relevant medical memo shall be provided by the hospital.

Download the Consent Form (116 KB, pdf) and send it together with any relevant document via postal mail to the following officer :-

Attention: Assistant Director Medical Department
Emergency Medical Services Branch, Level 9
HQ Singapore Civil Defence Force
91 Ubi Avenue 4
Singapore 408827

PAYMENT SERVICE SECTION
63.00

Note: If you do not have GIRO Account, please select 'Credit/Debit Card' as payment mode.