Pre-Visit Patient Forms & Information

General Forms and Procedures

At NextCare, we know that convenience is important to you. That’s why we make our patient intake, privacy and informational forms available to you prior to your visit. By checking in online and completing your forms prior to your visit, you can greatly reduce your wait time in our lobby.

If you have any questions prior to completing your forms, please call us at 888-381-4858.

Patient Privacy Forms

• Privacy Practice (PDF Version) – (HTML Version)
• Privacy and Billing Procedures – NextCare 10.05.15 (PDF Version) – (HTML Version)
• Privacy and Billing Procedures – NextCare Spanish Version 10.05.15 (PDF Version) – (HTML Version)

Registration Forms

• Patient Registration Form – NextCare Urgent Care (PDF Version) – (HTML Version)
• Patient Registration Form – NextCare Urgent Care – Spanish (PDF Version) – (HTML Version)

Medical Records Release Form

• Authorization to Release Protected Health Information (PDF Version) – (HTML Version)