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: You can print and complete this patient form in advance, or complete the copy provided at check in.
- Patient authorization form: 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. Patient authorization form (English & Spanish)
Primary Care - Patient forms
Patients will need to fill out a new patient authorization form, which is available at the primary care center upon check-in by front desk staff. Patients should also bring a valid photo identification, and copy of their current insurance card if paying with insurance.
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.
Patient Information Form (Spanish version) — 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 — available in both English and Spanish versions — may be printed and completed in advance, or a copy will be made available when the patient/employee arrives at a Concentra location.