Patient Registration
Acute Kids Urgent Care has simplified the registration process so that it should take less than two minutes to complete the one page form. The registration form may be completed at the clinic, or if you prefer, may be downloaded and completed at home.
A new registration form is required for every visit as it also includes the consent to treat your child on that date. If it is your child’s first visit to Acute Kids, we ask you to complete the full one page form. If you are a returning customer and your address has not changed, you may fill out the short form.
While your child is being treated, our staff will make a copy of your ID and insurance card, and enter all of this information into the system.
Registration Forms
The following forms can be filled out at home or in the clinic.
New Patient Form
Established Patient Form
Parent Questionnaire
Office Forms
This gives us permission to treat your child when you cannot be there
Our lawyers made us have one — it is really, really boring.
Use this form if you need medical records from us.
Use this form if you want your physician to send records TO Acute Kids.
All forms are in PDF format and require Adobe Acrobat to download. If you do not have Adobe Acrobat, you may download it here for free.
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