Report a Concern — Twin Township Ambulance

In an emergency, call 911. This form is not monitored in real time and is not for urgent situations.

Fields marked * are required. You can submit this anonymously. If you’d like to check on it later or receive a reply, choose the option to have a code emailed to you — your email is used only for that and is never attached to the report staff investigate.

What kind of report is this? *

About

If the list doesn’t fit, choose “Something else” and explain below.

Subject *

What happened? *

When did it happen?

Where?

Attach a file (optional — PDF or image)

How would you like to be contacted?

Stay completely anonymous (we can’t reply)

Stay anonymous, but email me a code so I can check status and get replies

Include my contact information

Your name *

Email *

We email you a reference code and PIN to check status. It is not stored with the report staff investigate.

Phone (optional)

I understand this form is not for emergencies and is not monitored in real time. *

Already have a code? Check your report

Your privacy

You may submit anonymously — we only know who you are if you choose to tell us.
If you ask for a status code, your email is used only to send that code and updates — it is never attached to the report our staff review.
Please avoid sharing more personal health information than needed.
Every report is reviewed as part of our quality and safety program.