Forms For Your Visit

Downloadable forms for patients and employers

Urgent Care - Patient forms


Employer 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.
  • Injury Information Form — This form gives your doctor more information about your injury. If you’ve been injured, please complete this form in addition to the patient information form and bring it to your visit.
  • 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.