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 forms
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.
Adobe Reader
You'll need Adobe Reader to view and print your patient forms. With this free download, you can access these forms prior to your visit, for added convenience.
