Patient Forms

First visit? Save time by printing & completing the registration form below.

We at Beaumont Urgent Care want to make your visit the best experience possible. If you are new and visiting for the first time, cut down on wait time and the registration process by printing the Patient Registration Form and filling it out prior to visiting one of our locations. This will allow our staff to provide faster service to get you feeling better and well on your way.

If you have any questions about our Patient Registration Form, please do not hesitate to contact us at one of our convenient locations!

Patient Form Links

Patient Registration Form (English) >

Patient Registration Form (Spanish) >

Patient Registration Form (Arabic) >

Medical Records Request Form >
(this links to our secure form platform,

Medical Records Fax: 833-922-0868

Customer Service: 610-994-7500, Option 1 (Requester Services department)

Attorneys & Insurance Companies

Medical Records Request Form

Attorney and Insurance Company Request for medical records follow the steps below:

1. Fax your request to – 833-922-0868

2. Email your requests to