Urgent Care and Worker's Comp Forms
For general urgent care visits (non-work-related), new patients only need to complete the Urgent Care Demographics and Policies form below—bring a photo ID and your insurance card if we will be billing insurance. For worker's compensation services (workplace injuries or occupational issues), download and review the additional relevant forms ahead of time. These help with registration, injury reporting, policies, and telehealth options as needed.
This document includes patient registration details, cell phone usage policies, and results communication guidelines for urgent care visits.
This form gathers your health history and current conditions to assess fitness for job duties in worker's comp evaluations.
This official California form is used to report occupational injuries or illnesses to insurers and authorities.
This agreement outlines expectations, privacy and policies for telehealth appointments in worker's comp cases.
This form details policies on appointments, cancellations, no-shows, and patient conduct for worker's comp services.
Employer Services Forms
For employer-paid physicals, pre-employment screenings, and occupational health services, these forms are required. Additional paperwork may be provided at check-in, and an employer authorization is needed for billing. Download and bring completed forms to your appointment.
This form collects basic patient information, contact details, employer info, and demographics for registration during employer services visits.
Gathers your health history and current conditions to assess fitness for job duties in pre-employment physicals.
This form is required for hearing tests as part of employer services.
This form authorizes drug screening and must be completed prior to testing.
This form is necessary for respirator fit testing and compliance with OSHA standards.
Other Forms
This form is for prospective employees to apply for positions at Pulse Urgent Care Center.
This Notice of Privacy Practices explains how Pulse Urgent Care may use and protect your medical information.