231 E. Caldwell Ave. - Visalia, Ca 93277
(559) 622-9800
iccvisalia@gmail.com

Patient Forms

Preparing for your visit just got easier!

Please be sure to download and review all the registration forms prior to visiting Immediate Care Center. To expedite the registration process, bring the completed forms to your first visit. Make sure to bring insurance cards and a photo ID.

1. Patient Registration

Please download the form, below

FILL OUT FORM
2. Health History

Please download the form, below

FILL OUT FORM
3. Financial & Billing Policy

Please download the form, below

FILL OUT FORM
4. Patient Rights & Responsibilities

Please download the form, below

FILL OUT FORM
5. Notice of Privacy Practices & Patient Consent

Please download the form, below

FILL OUT FORM
6. Notice of Privacy Practices

Please download the form, below

DOWNLOAD PDF

Contact Us

If you have any questions, please contact us and our staff will get to you as soon as possible.

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