REGISTRATION FORMS

SELECT  VISIT TYPE BELOW

Complete online, submit surely, and save time.

URGENT CARE / TELEMED
REGISTRATION and QUESTIONNAIRE

Tell us about your current symptoms. This will allow our Staff and Providers better prepare for your Office Visit today.

COVID-19 TESTING REGISTRATION and QUESTIONNAIRE

Complete your online registration and questionnaire. This will allow our Staff and Providers prepare for your Office Visit today. We will prepare a special Respiratory Exam Room for your visit, and prepare the appropriate COVID-19 testing for you.

Stay in your vehicle when you arrive.

Call our Urgent Care at 661-587-2500 or
Send SMS Text to 661-367-8897

Our Staff will provide you with further instruction.

NEW PATIENTS

MEDICAL HISTORIES

The information provided will help our Providers to better understand your overall health condition.