Printable Forms for Urgent Care Patients

At U.S. HealthWorks, we understand that you want to use your time efficiently, so we make it easy for you. In this section, you are able to conveniently print and fill in forms in the comfort of your own home, as well as pay your bill online at any time. U.S. HealthWorks provides convenient solutions for you.
Prior to arriving at a U.S. HealthWorks medical center, you may choose to print and fill in the necessary forms, ahead of time. Bringing them already completed will help shorten your registration process at the clinic and allow you to keep copies for future reference. Should you choose otherwise, these forms will be provided upon arrival by our front desk staff.
Patient Forms
Prior to an employee being provided services at one of our medical centers, we request that a Treatment /Service Authorization form be filled out by the employer or designee. This form should be brought by the employee at the time of service. In addition to medical treatment, all services required by the employer (including drug and alcohol tests) must be requested on the Treatment /Service Authorization form.
Urgent Care Patient Intake Forms (English / Español)
Influenza Vaccine Consent Form (English / Español)
Private Drug-Alcohol Screen Forms (English / Español)
Online Payment
With U.S. HealthWorks, you can securely pay your bill online using a credit/debit card or check. Save time and money on postage and check writing fees. It's fast and easy.
Patient Feedback
Help us improve our services by giving us feedback on your visit to our center. We want to know about your experience, whether it was outstanding or it could’ve been better. Our focus is quality healthcare, so we’re ready to listen. We want to hear from YOU!