Forms For Your Visit
Downloadable forms for patients and employers
Urgent Care - Patient forms
Each of the patient forms and documents listed here will be copied and kept in the patient’s permanent file.
Patient Information Form (English & Spanish) — You can print and complete this patient form in advance, or complete the copy provided at check in.
Patient Authorization Form (English & Spanish) — For urgent care (a non-work-related injury or illness), you’ll need to sign a patient form that authorizes Concentra to provide services. You can print and complete this in advance or at check in.
DOT CDL Forms
Patient Information Form (English & Spanish) — Every patient must complete and sign this form for his/her visit. The completed form is permanently filed in the patient’s chart. This form may be printed and completed in advance, or a copy will be made available when the patient/employee arrives at a Concentra location.
Employer Authorization Form — We must have a completed and signed Employer Authorization Form for any patient coming to a Concentra Medical Center for treatment of a first-time or new injury.