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What We Do
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What We Cover
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August 24th, 2023 |

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Free Air Ambulance Quote

Complete REVA’s quick and easy request form and get your air ambulance or medical escort quote, or call 1-954-730-9300.

REVA Accepts most major insurance. Humana in network.

Financing available for Florida residents.

Your Name*
Your Phone*
Your Email*
How did you hear about us?
Who referred you?
Pick-up Location*
Drop-off Location*
Patient Age
Please enter a number from 0 to 150.
Type of Transport?*
- Air Ambulance
- Medical Escort *
*Stable patient for commercial transport required
Does patient have insurance?
- Yes
- No
Is there a physician referral / doctor’s order for transport?
- Yes
- No
Patient Insurance Company Name
What else would you like to tell us?
Patient Name*
Patient Date of Birth*
MM slash DD slash YYYY
Primary Insured Name*
Insurance Policy Number*
Insurance Group Number*
Insurance Company Phone*
Comments
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