statcare Urgent Care Near Me

Patient Forms

Thank you for selecting Statcare Urgent Care in  Hicksville, Long Island; Astoria, Queens; Brooklyn, NYC; the Bronx at Bartow Avenue (Co-op City); the Bronx at E. 174th Street; Jackson Heights, the Queen; Midtown Manhattan in Manhattan and Jamaica, Queens. You may pre-register by downloading, printing, and completing the forms below. Please be sure to bring them with you to your visit. Completing the forms prior to your visit will help speed up the registration process.

Downloadable Forms:

Patient Treatment Agreement
Financial Policy Agreement
Privacy Practices – English
HIPAA Compliance
Patient Registration Form
Antibiotic Patient Education
TeleHealth Consent Form
HRM 18F – Release of Medical Records Form

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

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