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); and the Bronx at E. 174th Street. 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.

• Patient Registration Form
• HRM 18F – Release of Medical Records Form
• Privacy Practices – English

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.