Practice Documents

Documents | Forms | Patient Education

Documents can be opened in Google Chrome and completed online before printing.

CONSENT FORMS

Urgent Care Consent Forms

Consent Estradiol & Testosterone Implants UC1100

Consent Estradiol & Testosterone Implants UC1100

Consent for Prodecure UC1100

Consent for Prodecure UC1100

Consent Testosterone Pellet Implantation-UC1100

Consent Testosterone Pellet Implantation-UC1100

Physical-Exam-Consent UC1100

Physical-Exam-Consent UC1100

Weight Management Consent Semaglutide UC1100

Weight Management Consent Semaglutide UC1100

X-ray Consent-UC1100

X-ray Consent-UC1100

PATIENT CONSENT FORM FOR AI DICTATIONS-TCUC

PATIENT CONSENT FORM FOR AI DICTATIONS-TCUC

CREDIT CARD AUTH

Urgent Care Credit Card Authorization Form

Credit Card Auth Form UC1100

Credit Card Auth Form UC1100

IV THERAPY

All forms relating to IV Therapy.

IV-Therapy-General-Release UC1100

IV-Therapy-General-Release UC1100

MEDICAL FORMS

All internal forms relating to patient visits

10-Pnl-Drug-Screen-UC1100

10-Pnl-Drug-Screen-UC1100

12-Pnl-Drug-Screen-UC1100

12-Pnl-Drug-Screen-UC1100

5-Pnl-Drug-Screen-UC1100

5-Pnl-Drug-Screen-UC1100

Aging-Male-Symptoms-Scale-UC1100

Aging-Male-Symptoms-Scale-UC1100

AMA-Form-UC1100

AMA-Form-UC1100

AOB-From-UC1100

AOB-From-UC1100

Corporate-Pre-Employment-Physicals-UC1100

Corporate-Pre-Employment-Physicals-UC1100

Drug-Screen-Intake-UC1100

Drug-Screen-Intake-UC1100

Drug-Testing-Release-UC1100

Drug-Testing-Release-UC1100

Firefighter-Physical-Checklist-UC1100

Firefighter-Physical-Checklist-UC1100

Free-Of-Communicable-Disease-UC1100

Free-Of-Communicable-Disease-UC1100

Hearing-Screening-Form-UC1100

Hearing-Screening-Form-UC1100

HEP-A-Vaccine-UC1100

HEP-A-Vaccine-UC1100

HEP-AB-TWINRIX-Vaccine-UC1100

HEP-AB-TWINRIX-Vaccine-UC1100

HEP-B-Vaccine-UC1100

HEP-B-Vaccine-UC1100

HPV-Vaccine-UC1100

HPV-Vaccine-UC1100

Influenza-UC1100

Influenza-UC1100

Meningococcal-Vaccine-UC1100

Meningococcal-Vaccine-UC1100

Menopause-rating-scale-UC1100

Menopause-rating-scale-UC1100

MMR-Vaccine-UC1100

MMR-Vaccine-UC1100

Patient In-house Lab Result Sheets

Patient In-house Lab Result Sheets

Patient Required Testing-Procedures-DME Sheet

Patient Required Testing-Procedures-DME Sheet

PIP-Form-UC1100

PIP-Form-UC1100

Pneumococcal-Vaccine-UC1100

Pneumococcal-Vaccine-UC1100

PPD-Results-UC1100

PPD-Results-UC1100

PPD-Test-UC1100

PPD-Test-UC1100

PPD-Xray-Report-UC1100

PPD-Xray-Report-UC1100

Pre-OP Questionnaire-UC1100

Pre-OP Questionnaire-UC1100

Procedures-Self-Pay-Cost-Proposal-UC1100

Procedures-Self-Pay-Cost-Proposal-UC1100

Promise-To-Pay-UC1100

Promise-To-Pay-UC1100

Qualitative-Respirator-Fit-Record-UC1100

Qualitative-Respirator-Fit-Record-UC1100

RABIES-Vaccine-UC1100

RABIES-Vaccine-UC1100

Self-Pay-Patient-UC1100

Self-Pay-Patient-UC1100

Shingles-Vaccine-UC1100

Shingles-Vaccine-UC1100

Standardized-Assessment-of-Concussion-UC1100

Standardized-Assessment-of-Concussion-UC1100

TD-TDAP-Vaccine-UC1100

TD-TDAP-Vaccine-UC1100

VA-Information-Form-UC1100

VA-Information-Form-UC1100

Varicella-Vaccine-UC1100

Varicella-Vaccine-UC1100

WellPath-FDLE-LAW-ENFORCEMENT-CHECKLIST-UC1100

WellPath-FDLE-LAW-ENFORCEMENT-CHECKLIST-UC1100

WellPath-Pre-Employment-UC1100

WellPath-Pre-Employment-UC1100

WellPath-PreEmployment-Checklist UC1100

WellPath-PreEmployment-Checklist UC1100

Workers-Comp-Incident-UC1100

Workers-Comp-Incident-UC1100

NEW PATIENT FORMS

These documents are available to patients on the website at tcurgentcare.com under the resources menu.

HIPAA-Privacy-UC1100

HIPAA-Privacy-UC1100

HIPAA-Privacy-UC1100 SPANISH

HIPAA-Privacy-UC1100 SPANISH

LiveHearty-Packet-8-23-23

LiveHearty-Packet-8-23-23

Medical-Records-Release-UC 1100

Medical-Records-Release-UC 1100

New Patient Packet

New Patient Packet

UC SuperBill Template

UC SuperBill Template

PATIENT EDUCATION

To be given to patient upon administration of corresponding vaccine.

WEIGHT MGMT

Weight Management Documents for Urgent Care

Semaglutide Attention UC1100

Semaglutide Attention UC1100

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