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Emergency: +263 782 999 901/2/3/4

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ACE Air & Ambulance
  • Home
  • Services
    • Air Ambulance
    • Road Ambulance
    • On-site Ambulance and Paramedic Services
    • Helicopter and Remote Rescue Service
    • Clinic Services
    • Call Centre Service
    • Car Accident Cover
    • Event standby
  • Sign-up
    • For Individuals
    • For Family
    • For Corporates
    • Car Cover
  • Training Academy
  • About
  • Contact
  • Payment Points

Emergency Medical Rescue Application Form - Individual

Emergency Medical Rescue Membership Package Application Form

Step 1 of 3

33%

Personal Details

Name
National ID/ Passport/Drivers' Licence
DD slash MM slash YYYY
Please include country code
Address

Medical History

Have you ever suffered from a heart condition?
Have you ever been in hospital in the last year?
Have you ever been diagnosed with:
Indicate any allergies and pre-existing conditions you might have. Type Non if nothing
Please share any relevant medical history details we would need to know before assisting you in an emergency.

Select service and duration

Service type
Please select a monthly period for all services except Zambezi Cover (Tourist) which is per night.
Select subscription duration. Minimum 6 months. 1 to 5 are for Zambezi Cover - Tourist

Payment details

Payment Method
Consent
Introduction:
Welcome to ACE Air and Ambulance (Pvt) Ltd, your trusted partner in healthcare services. Before you proceed with the registration for our Electronic Medical Records (EMR) service, please take a moment to read and understand the following consent document.

Consent to Electronic Medical Records (EMR) Service:

By submitting this registration form, you are providing your explicit consent to ACE Air and Ambulance (Pvt) Ltd to collect, store, and manage your electronic medical records for the purpose of facilitating and improving healthcare services. This includes but is not limited to personal information, medical history, diagnostic reports, treatment plans, and any other relevant health information.

Data Security and Confidentiality:

ACE Air and Ambulance (Pvt) Ltd is committed to ensuring the security and confidentiality of your electronic medical records. We implement industry-standard security measures to protect your data from unauthorized access, disclosure, alteration, and destruction.

Purpose of Data Collection:

The primary purpose of collecting and maintaining your electronic medical records is to enhance the efficiency and quality of healthcare services provided by ACE Air and Ambulance (Pvt) Ltd. Your information may be used for medical diagnosis, treatment planning, billing, quality assurance, and research purposes, always adhering to applicable laws and regulations.

Sharing of Information:

Your electronic medical records may be shared with authorized healthcare professionals and organizations involved in your care, including but not limited to physicians, nurses, emergency medical personnel, and other relevant healthcare providers. ACE Air and Ambulance (Pvt) Ltd will not disclose your information to third parties without your explicit consent, except as required by law.

Access and Control:

You have the right to access, review, and update your electronic medical records. If you wish to make any changes or request the removal of specific information, please contact ACE Air and Ambulance (Pvt) Ltd through the provided channels.

Withdrawal of Consent:

You have the right to withdraw your consent for the use and storage of your electronic medical records at any time. However, withdrawal may impact the quality and continuity of healthcare services provided by ACE Air and Ambulance (Pvt) Ltd.

Questions and Contact Information:

If you have any questions or concerns about this consent document or the use of your electronic medical records, please contact our Privacy Officer at [email protected]

I have read, understood, and consent to the terms outlined in this document:

Harare Base

  • +263 782 999 901/2/3/4
  • [email protected]
  • [email protected]
  • 2 Mount Road, Avondale, Harare

Chinhoyi Base

  • +263 782 997 997
  • [email protected]
  • Sunningdale Trust, Mari Road
  • Chinhoyi

Bulawayo Base

  • +263 771 602 399
  • +263 719 999 302
  • [email protected]
  • Garden Park Trust,
  • Retirement Home,
  • Bulawayo

Victoria Falls Base

  • +263 784 810 026
  • +263 715 501 222
  • [email protected]
  • 1st Floor, Elephants Walk Village
  • 273 Adam Stander Road, Victoria Falls

Chirundu Clinic & Base

  • +263 780 869 169
  • Tiger Safaris Road,
  • Opposite River God,
  • Chirundu

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