Visit Registration Request
Next Generation Pediatric Urgent Care
Pre-registration only:
This is a walk-in registration request only. It does not guarantee an appointment time. Patients are seen based on order of arrival, clinical priority, and clinic flow.
Patient status
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Select one
Existing patient
New patient
Date of birth
*
Approximate arrival window
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Select one
Within 30 minutes
30 to 60 minutes
1 to 2 hours
Later today
Patient first name
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Patient last name
*
Reason for visit
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Parent/guardian name
*
Parent/guardian phone
*
Parent/guardian email
*
I consent to receive registration/check-in instructions by text or email.
*
I understand this is pre-registration, not an appointment or guaranteed visit time.
*
*
Required fields
Submit pre-registration request