Forms for Medics
EMS State License Application (Initial application for both In-State and Out-of-State applicants)
Fingerprint Background Process Instructions
Individual License Renewal Application (not available for new applicants)
C-09-A Voluntary Surrender Form
Personnel Information Change Form
Verification of Lawful U.S. Residency Form
Arrest or Criminal Charge Form
Support Letter for NREMT Pathways for Registration
Forms for Ambulance Services - Corporations and LLCs ONLY
New Ambulance Service License Application
EMS Service License Application Packet
Vehicle Inspection Forms
R-E-01-A Vehicle Inspection Form - Ground Ambulance
R-E-01-B Vehicle Inspection Form - Neonatal Ambulance
R-E-01-C Vehicle Inspection Form - Medical First Responder
R-E-01-D Vehicle Inspection Form - Air Ambulance
Current Ambulance Service Renewal Application
EMS Service License Renewal Application Packet
Current Ambulance Service Revision Forms
Use the following revision forms to add or delete base and satellite locations, vehicles and EMS personnel.
Add/Delete Base and Satellite Locations
Add/Delete Ambulance Vehicles
Add/Delete Licensed EMS Personnel
Update Insurance - Submit Acord Form 25 and Acord Form 101 (must list all insured vehicles).
For other revisions please use the EMS Service License Application Packet be sure to mark "Revision" on the application.
Forms for Ambulance Services - Governments, Authorities, and Sole Proprietors ONLY
New Ambulance Service License Application
EMS Service License Application Packet (GA EMS 1000)
Vehicle Inspection Forms
R-E-01-A Vehicle Inspection Form - Ground Ambulance
R-E-01-B Vehicle Inspection Form - Neonatal Ambulance
R-E-01-C Vehicle Inspection Form - Medical First Responder
R-E-01-D Vehicle Inspection Form - Air Ambulance
Current Ambulance Service Renewal Application
EMS Service License Renewal Application Packet (GA EMS 1000)
Current Ambulance Service Revision Forms
Use the following revision forms to update insurance, add or delete locations, vehicles and EMS personnel.
Update Insurance Information - Schedule A
Add/Delete Base Locations
Add/Delete Licensed EMS Personnel - Schedule E
Add/Delete Ambulance Vehicles - Schedule F
For other revisions please complete them on the EMS Service License Application Packet (GA EMS 1000) be sure to mark "Revision" on the application.
Service Online Group Renewal
Forms Related to Education
Specialty Designation Information
For information regarding EMS Procedures, Forms and Resource Documents contact the State Office of EMS at 770-996-3133 or your Regional EMS Office.
Page last updated 10/1/18