Registration Forms

All new patients must download, complete, and submit these forms before doing a telehealth or phone consultation. Once you complete the registration forms email them to us at CovinaUrgentCare@gmail.com

To reduce your wait time for walk-in visits, email your forms to us before driving here, or print the forms and bring them in completed.

New Patient Registration

English Fillable PDF

Download

Established Patient Registration

English Fillable PDF

Download

Pre-Register for an in-office visit

We know your time is valuable and want to make your visit as quick and efficient as possible. Reduce your wait time pre-registering below

    Telehealth consultation

    If you prefer to schedule a consultation via video chat or telephone, we offer Telehealth booking. 

    Please note, the designated hours for Telehealth and Phone Consults are 6pm-8pm weekdays and 10am-12pm weekends. We will do our best to accommodate you as close to your requested time as possible. 

     

    Coming Soon