Registration Forms

Help us to help you faster

We have made available some of the registration forms that we need to better serve our patients and get you the help that you need in a timely manner. If you have the time to print and fill these out and bring them with you, then we can process them quicker.

Other Important Items to Bring:

  • Insurance Card

  • Photo ID

  • Co-Pay

Insurance Accepted

  •   Blue Cross Blue Shield

  •   Cigna

  •   Aetna

  •   United Health Care

  •   Humana

  •   Tricare

  •   Medicare

Premier Urgent Care

5856 Highway 53, Suite 200A
Harvest, AL 35749

Fax: 866-213-6061

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