In effort to minimize time needed to complete your office registration we have supplied the Urgent Care forms. It is in editable PDF format and could be filled out using a compatible web browser or Adobe Acrobat Reader. Get Adobe Acrobat Reader

For New Urgent Care Patient:

We want your to visit to be as convenient as possible.

Please bring with you:

  • Driver’s license or Photo ID
  • Insurance Information
  • Payment for co-pay or self-pay
  • List of medications, allergies, past surgeries

Download Forms
EMR Registration (English).pdf
EMR Registration (Espanol).pdf


For Employee Urgent Care Patient:

Please bring the following:

  • Filled out Authorization Slip Form
  • Filled out Medical Examination Report Form (For DOT only)
  • Filled out History of Work-Related Accident Form (Spanish / English)
  • Filled out UCC-Physical Examination Form

Download Forms
Authorization Slip.pdf
History of Work Related Accident.pdf
Historia De Accidente De Trabajo.pdf
UCC – Physical Examination Form.pdf
Medical Examination Form (DOT only)

Urgent Care Email address: gatewayurgentcaremanager@pmcamd.com

If this is an emergency, call 911 emmediately.