Patient Registration

Medical City Children’s Urgent Care has simplified the registration process so that it should take less than two minutes to complete the one page form.

A new registration form is requested for every visit as it also includes the consent to treat your child on that date. If it is your child’s first visit to a Medical City Children’s Urgent Care clinic, we ask you to complete the full one page form. If you are a returning customer and your address and/or insurance has not changed, you may fill out the short from.

While your child is being treated, our staff will make a copy of your ID and insurance card and enter all of this information into the system.

Registration Forms

Download and print forms or complete at the clinic if you prefer.

Release of Information for Medical City Children's Urgent Care

HIPAA Acknowledgment and Consent

All forms are in PDF format and require Adobe Acrobat to download. If you do not have Adobe Acrobat, you may download it for free.