Tri-Community Ambulance 

Proudly serving the residents of the Bergholz, Pekin, Sanborn and St. Johnsburg Fire districts since 1956!

Patient Medical History Forms

How do you ensure emergency services knows your medical history, allergies, and current medications taken?  What happens if you are unable to verbalize these to responders?  We recommend that you have your medical history information readily available for responders by completing a medical history form and posting it on your refrigerator or other easy to locate area.

Tri-Community Ambulance Service, Inc. Personal Medical History Form

American College of Emergency Physicians

Good Housekeeping Medical Forms

Emergency Care for You downloadable forms