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EMS COMPLAINT FORM

EMS/Ambulance Permits office - telephone 713-640-4370
EMS/Ambulance Permits office - e-mail ems.hdhhs@cityofhouston.net

Name of Ambulance Company:
 
Ambulance Comany Phone Number:
 
Type of Violation Observed:
 
Location of Violation:
 
Date of Violation:
 
Time of Violation:
 
 
Your Name:
 
Your Phone:
 
Additional Comments: