Anaheim, CA · Orange County
FireMedics Program Application
Anaheim residents and businesses use this application to enroll a household or business in the FireMedics membership program.
What this form is
This application enrolls an Anaheim household or business in the FireMedics Program, which can help members avoid remaining paramedic and ambulance response fees after insurance pays. Applicants provide contact and utility account information, choose a payment method, and include a check or money order if paying by mail. The form lists a prorated payment table for late enrollment and describes the membership year as July 2026 through June 2027.
Who needs it
Anaheim residents or businesses seeking FireMedics coverage for household members or employees can use this application to enroll.
How to submit it
Mail the completed application and payment to Anaheim Fire & Rescue, Attn.: FireMedics Program, 201 S. Anaheim Blvd. #300, Anaheim, CA 92805. To apply online, use Anaheim.net/FireMedics; do not fill out this application for online enrollment.
About notarization
No notary is needed; the applicant signs and dates the application, and the document mentions no notarized or sworn attachment.
How to submit this form
- 1
Download The Application
Download the FireMedics Program Application for paper enrollment. If applying online, do not fill out this application.
- 2
Complete The Application
Print clearly and provide the requested contact and utility account information; indicate whether you are enrolling a household or business.
- 3
Choose Payment And Gather It
Choose to add the fee to your Anaheim Public Utilities bill or include a check or money order payable to the City of Anaheim.
- 4
Submit To Anaheim Fire & Rescue
Mail the completed application and payment to the FireMedics Program address printed on the form, or apply online at Anaheim.net/FireMedics.
Frequently asked questions
- Who can apply for the FireMedics Program?
- The document identifies Anaheim residents and businesses as eligible. Coverage includes everyone living in an enrolled household or employees working at an enrolled business.
- How do I submit the FireMedics application?
- Mail the completed application and payment to Anaheim Fire & Rescue at the address printed on the form. For online enrollment, visit Anaheim.net/FireMedics and do not fill out this application.
- Do I need a notary for the FireMedics Program Application?
- No. The applicant signs and dates the application; the document mentions no notarized or sworn attachment.
- How can I pay for membership?
- The form allows the fee to be added to an Anaheim Public Utilities bill or paid by check or money order. It says not to send cash and includes prorated amounts for enrollment after the membership year starts.
Need something notarized?
This FireMedics Program Application doesn’t need a notary — but if you have another Anaheim form that does, a commissioned online notary can help.