Forms

PREMIER URGENT CARE makes registration easy for first time patients. If you have not visited a PREMIER location since January 1st, 2014, you will be asked to fill out a new registration packet.

First time patients can find the patient registration form by clicking the link to the left. Complete the indicated fields and present the completed form to our receptionist upon arrival. If you have questions about your registration form, your receptionist will be able to assist you upon arrival.

Our Occupational Medicine and Workers Compensation packets are also available to the left. Workers Compensation packets must be completed for each new injury.

PREMIER requires a Personal Healthcare Information (PHI) Release Authorization to transfer your medical records. Please complete the PHI Release Authorization form as well and fax to any one of our PREMIER locations. (You will find the fax number on each individual location page.)


Medical Forms