Document Center and Links

Request for Service Fax Form
Billing | Physician's Certification Form
Billing | Indigent Financial Form
Billing | Payment Agreement
Billing | Prospective Payment System (PPS)
Billing | Rate Sheet
Billing | Case Management - Info Letter
Billing | Medicare Redetermination Form
HIPPA
Do Not Resuscitate Order (DNRO) DH Form 1896
Billing Lifetime Authorization Form
Supplemental PCS form

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Contact Us

Coastal Health Systems of Brevard
486 Gus Hipp Blvd
Rockledge, FL. 32955
Phone: (321) 633-7050
Fax: (321) 632-3005
Email: info@coastalhealth.org

Testimonials

Excellent service! I cant express how thankful I am. They made me feel at ease. My 1st ambulance experience.

July 2016

My experience riding in transport was pleasant and relaxed, thank you<3

January 2017

Whatever professional is, your CHS staff was, they actually refocused my pain.

Feb 2016

Everything was just fine.

July 2016

They made me smile on a scary night.

May 2016