Emergency Medical Information Form Order Number This form is provided by and maintained by National Set & Event Medics to help our medical staff treat you in the event you are incapacitated. This form confidential. Download the printable copy here: http://emi.nationalsetmedics.com First Name * Last Name * Mobile Number * Email Address * Emergency Contact Person * First and Last Name | Preferably someone not with you Emergency Contact Phone Number * Relationship to you * Do you have any Allergies? * If none type none What Medications are you taking? * If none, type none Past Medical History * If none, type none What is your doctors name? * If none, type none Doctors Phone Number * If none, type none Any Additional Notes? Consent to Treat: I authorize National Set & Event Medics to provide emergency and non-emergency medical treatment for the duration of the event. National Set & Event Medics will not be responsible for any medical bills incurred. I may refuse treatment at any time. https://www.nationalsetmedics.com/privacy-policy/ *
