Urgent Care Treatment Consent & Authorization Form

Streamline Urgent Care Intake with a Professional Treatment Consent Form

Urgent care facilities need to move quickly while maintaining full regulatory compliance. This Urgent Care Treatment Consent & Authorization Form template helps your clinic collect essential patient consent, HIPAA authorizations, and payment acknowledgments in one streamlined digital experience.

Built for Healthcare Providers Who Value Efficiency and Compliance

Whether you're running a standalone urgent care center, a hospital-affiliated walk-in clinic, or a multi-location healthcare group, this template addresses the core documentation needs of same-day medical care. It captures treatment consent, prescription authorization, walk-in acknowledgment, primary care follow-up recommendations, and financial responsibility—all in compliance with HIPAA standards.

Paperform is trusted by healthcare administrators, medical office managers, and practice owners who need professional, secure forms that patients can complete before arrival or on a tablet in the waiting room. With SOC 2 Type II compliance and data residency controls, Paperform provides the security healthcare organizations require.

Key Features for Urgent Care Workflows

This template includes sections for:

• Patient demographics and emergency contact information
• Insurance verification and payment responsibility acknowledgment
• HIPAA privacy practices acknowledgment
• Treatment consent with clear medical procedure language
• Prescription and medication authorization
• Walk-in service acknowledgment
• Primary care provider follow-up recommendations
• Release of information consent

You can embed this form on your website, send it via email or SMS before appointments, or display it on tablets in your lobby. Responses sync directly to your practice management system via Stepper (stepper.io), Zapier, or webhooks.

Automate Follow-Up and Records Management

Once a patient submits the form, use Stepper to automatically:

• Create patient records in your EMR or practice management software
• Send intake summaries to the attending physician
• Route insurance verification to your billing team
• Trigger follow-up appointment reminders
• Generate visit documentation for compliance audits

For forms that require signatures—such as consent for specific procedures—pair this template with Papersign (papersign.com) to capture legally binding eSignatures and maintain a complete audit trail.

Designed for Healthcare Professionals

This form is ideal for urgent care physicians, nurses, medical assistants, healthcare administrators, and billing specialists who want to reduce wait times, improve patient experience, and maintain meticulous records. Customize the template to match your clinic's protocols, add your logo and brand colors, and adjust questions based on your state's consent requirements.

Get started with Paperform's free plan or upgrade to unlock advanced features like conditional logic, payment collection, HIPAA-compliant data handling, and team collaboration tools.