Forms

Once you arrive at Quick Care, please be prepared to provide the following information. This will allow us to serve you more quickly.

• Patient and policy holder name, social security number, date of birth, address and telephone number
• Picture ID
• Current insurance card
• Your co-payment or deductible amount, if applicable, is requested at the time of service
• Your primary care physician's name
• List of your current medications, including over-the counter and prescription.

For your convenience and to expedite the registration process, our registration forms are provided below. You may choose to print and complete these forms prior to your arrival.

• New Patient Information Record
• Consent to Treat