Online Patient Registration Form

Thank you for opting to fill out the secure online version of our Patient Registration Form. Please note that Urgent Care is a walk-in facility and that registering online is not the equivalent of making an appointment, nor does your estimated arrival time necessarily designate the time that you will be seen by a physician.

Please click on the link to the appropriate form:

• Online Patient Registration Form   most common
  For patients who are seeking treatment for any non-life-threatening injury or illness as a general visit and not as a re-check.



• Recheck Form
  For patients who need a recheck for a visit made within the past 30 days. This recheck visit must be for the same illness or injury as the primary visit.



• Worker's Compensation Form
  For patients who have been injured in the course of employment.