This is a form to submit a complaint regarding quality of care, fraudulent credentials or other misconduct by a healthcare provider. If you prefer to have this form mailed to you, please call 860-509-7975.
EMS Instructor Course Forms
Forms for EMS Instructors applying to conduct training courses.
For Initial Certification Training Programs:
For Recertification Training Programs:
Application to Conduct Paramedic Recertification Programs Form (T1)
EMR/EMR Refresher/EMT Refresher written exam roster
EMS Provider Licensing & Certification ApplicationsPlease visit our Licensing & Certification page Opens in a new window Opens in a new window for more information and instructions to apply for certification and licensure for all clinical EMS providers. Below you will find forms for currently certified or licensed EMS providers.
EMS Organization Forms
Forms for organizations to apply for new or expanded services, PSAR designation, change in authorization, new vehicles, change in sponsor hospital, or to add authorized skills.Need for Service Application
Please Note: Some files are in Portable Document Format (pdf). You will need Adobe Acrobat Reader to view and print the information. For fillable pdf forms, you must download and save the form to your computer for the full functionalities to work. Other files are in Microsoft Word or Excel Format (.doc or .xls). You will need Microsoft Word and/or Excel to view and print this information.