LEARN ABOUT OUR COVID-19 OPERATIONAL CHANGES

Covina Urgent Care

Covina Urgent CareCovina Urgent CareCovina Urgent Care

insurance & Pricing

Registration Forms

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Services
insurance & Pricing
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Registration Forms

Covina Urgent Care

Covina Urgent CareCovina Urgent CareCovina Urgent Care

insurance & Pricing

Registration Forms

Home
Services
insurance & Pricing
SCHEDULING
Contact Us
Registration Forms

Home
Services
insurance & Pricing
SCHEDULING
Contact Us
Registration Forms

Hours of Operation

Monday-Friday 3pm-9pm

Saturday-Sunday 9am-3pm

Updated 9/16/2020

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 Fillable Form [English] (pdf)Download

Returning Patient Registration Fillable Form [English] (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

Name*

Date of Birth*

Phone*

Email*

Insurance Name*

Insurance ID Number*

Estimated Arrival Time*

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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.

Copyright © 2020 Covina Urgent Care - All Rights Reserved.

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