Patient Forms

Forms for all patients (except for those coming in only for a flu shot):

Patient Registration Form
NUC/BUC Health History Form
NUC Telemed Consent Form
Financial Agreement

Patients coming in for a Flu Shot should complete the following:

Influenza Vaccine Consent Form

Also, please read this Influenza Information Sheet

In order to treat an unaccompanied minor (under the age of 18), the following form must be filled out:

Authorization to Treat a Minor

In order to release Health Care information, the following form must be filled out:

Authorization to Release Health Care Information

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    “The whole team are extremely helpful and actually care about your well-being and helping you out. Some of the staff that really stood out and went above and beyond Odessa – PA...

    Marie Fitch

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    “This was the nicest, cleanest, fastest urgent care I’ve ever been to. I only waited an hour. Everyone was kind and helpful. I will be coming back here the next time I need car...

    Anne B

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    “Repaired a sliced thumb without delay; carefully examined and exhaustively cleaned multiple times, brilliantly taped up to avoid the need for stitches and it resulted in it healing ...

    Jim F

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    “I went in today for a drug screening and was disrespected at the most part after I got in as an African American and they seen who I was 1 of the guys working there pushed me for no...

    Tone Bee

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    “Wow. I just came here freaking out feeling like I couldn’t breathe. The front desk lady was very nice and said There are 7 people in front of me. I asked her if she could at l...

    Kimberly Morrow

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