New Patient Forms

new-patient-formsSave time when you arrive at Compass Urgent Care by filling out a New Patient Registration Form now.

If you have never been a patient at Compass Urgent Care, simply fill out the secure form below and click submit. When you visit one of our offices, inform the receptionist that you submitted your Registration Form online. It’s that easy!

If you would rather download and print the forms to submit at the time of your visit, simply print the forms below, fill out the information and bring the forms to Compass Urgent Care.

Click on a form title to view and print the form or right click to save as a PDF to your computer for printing.

New Patient Registration Form

Patient Receipt Of HIPPA Privacy Notice Form

For any questions or concerns, please feel free to call our office at
(251) 633-CARE.

Online New Patient Registration Form

Select a Location

Your Personal Information


Emergency Contact Information

Your Employer Information

Primary Insurance Information

Secondary Insurance Information

Guarantor Information

Enter the characters you see above in the field below.

Compass Urgent Care