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Request Insurance Information

Often times it is necessary for our billing department to gather insurance information from the responsible party of a patient Urbandale Fire Department attended to.  We will contact you regarding this information and will need an authorization form completed by the responsible party.  This form can be downloaded here to facilitate the billing process.  Once this form has been completed it will need to be faxed or mailed directly to our billing department.

Download a printable version of the Insurance Information Form (PDF)

To return the completed form you can mail it to:

Urbandale Fire Department
Attn: Lesley Olsasky
3927 121st Street
Urbandale, Iowa 50323
It can also be faxed to: (515) 278-3872, Attention: Lesley Olsasky
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