Health Care in Dodgeville WI | Upland Hills Health

For EMS use only!To send information to the Emergency Dept. Director and the Emergency Medical Director at Upland Hills Health, FILL OUT THE FORM, and SUBMIT.

Fields marked with an asterisk (*) are required.

Date*
Date Format: MM slash DD slash YYYY

(Someone from our staff will reply within five business days)
EMS Information
EMT Name:*
EMT Email:
Service:
Training Officer:*
Training Officer Email:
* All patient information is sent to a service's training officer. Please check with him/her for follow-up information.
Transport Information
Patient Name:*
Date of Birth:
Date Format: MM slash DD slash YYYY
Date:*
Date Format: MM slash DD slash YYYY
Time:*

: HH

MM
List Information Desired:
Please answer the following question regarding your interaction with the ED
I was treated with courtesy and respect by ED staff:*
Other Comments:
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Comments
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Does my insurance work with Upland Hills Health?

It’s one of the most common questions our patient financial services experts get.

Most people are surprised to learn that Upland Hills Health works with a wide range of health plan and PPOs. We are an independent, nonprofit healthcare organization, always pursuing additional insurance carriers that service our communities.

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