Complete this online registration form to save time when you arrive for your scheduled appointment on the same business day or the following few days.

How does this save time?  By pre-registering, our staff is able to enter your demographic information into our electronic medical record system and verify your insurance information prior to coming in.  Then, when you arrive, we only need a copy of your ID and insurance card(s) and your signature authorizing treatment.

Please remember to bring your drivers license and health insurance cards.

For minor patients under the care of someone other than a parent or legal guardian, please have the parent or legal guardian fill out a CONSENT TO TREAT MINOR CHILDREN form in addition to the pre-registration form below. A photo ID of the parent or legal guardian must accompany the Consent To Treat Form.

• Chronic Pain Management
• Pregnant Patients

Due to the nature of this practice, Atlantis Urgent Care will NOT fill out physician’s statements for temporary or permanent disability claims. Forms affiliated with temporary sickness such as Aflac, FMLA, or travel changes will incur a $75 fee for completion. Should you require doctor’s notes in order to assist with filing a claim we will be happy to provide them at no charge.

Preregister Online Form

OR

If you wish to download our Registration Form, click the link below to print a copy. Please bring this form with you to your next visit.