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Patient Resources

Patient Forms

Complete your forms before you arrive and spend less time in the waiting room.

New Patient Form

Complete this if it’s your first visit to any Health Express Urgent Care center. Includes demographics, insurance, medical history, and current medications.

Existing Patient Form

Returning to us? Confirm your information and tell us what brings you in today so we can move you through faster.

Patient Consent to Treatment

Standard consent for evaluation and treatment, release of medical information to your insurer, and assignment of benefits.

Before you walk in

  • Bring a photo ID and your insurance card
  • List current medications, allergies, and prior surgeries
  • For a minor, a parent or guardian must sign the consent form
  • For a work injury, bring your employer and claim information
Insurance & self-pay
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Urgent care

Forms done? Hold your place in line

Check in online before you leave home, call us with questions, or get directions and walk in today.

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Call (216) 777-2155
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Avon Lake
Cleveland
Hartville
Mayfield Heights
Middleburg Heights
North Olmsted
North Ridgeville
Parma
Shaker Heights
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