Urgent Care Intake Form

The Urgent Care Intake Form is optimized for speed without sacrificing completeness. Walk-in clinics and urgent care centers operate at a different pace than scheduled practices, and this template reflects that reality. It captures the essential information in a concise, single-page format: chief complaint, symptom onset and progression, allergies, current medications, and relevant medical history.

The chief complaint section uses smart categorization to help patients describe their symptoms quickly -- selecting from common urgent care presentations like respiratory symptoms, injuries, abdominal pain, fever, and skin concerns. Symptom timeline questions establish acuity and help with triage prioritization.

Despite its brevity, this form does not skip critical safety checks. Allergy documentation, current blood thinners and medications, and relevant medical conditions (diabetes, heart disease, immunocompromised status) are captured to prevent adverse events. Insurance and ID information can be collected simultaneously to speed up the registration process.