Patient Forms

General Information

When you visit a St. Francis Urgent Care, please be prepared to provide the following information:

  • Whether you have been a patient before
  • Patient and policy holder name, social security number, date of birth, address and telephone number
  • Picture ID
  • Current insurance card
  • Your co-payment or deductible amount, if applicable, is due at the time of service
  • Your primary care physician's name
  • List of your current medications

This information is needed to expedite your registration and to assist us in understanding the urgency of your visit. Thank you for choosing St. Francis Urgent Care for your healthcare needs.