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Champlain Medical Urgent Care New Patient Welcome Sheet How did you hear about Champlain Medical Urgent Care: c Friend c Drive By c Flyer c TV / Radio / News c Web c Employer c Insurance c Other Date:
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How to fill out Champlain Medical Urgent Care:

01
Gather your personal information: Before filling out the form, make sure you have all the necessary personal details handy, such as your full name, date of birth, address, and contact information.
02
Understand your medical history: The form may ask for information regarding your medical history. It's important to review your medical records and be prepared to provide accurate information about any past illnesses, surgeries, medications, or allergies you may have.
03
Consider the reason for your visit: Champlain Medical Urgent Care is designed to provide immediate medical attention for non-life-threatening conditions. Assess your symptoms and be prepared to describe the main reason for your visit, whether it's a minor injury, illness, or any other medical concern.
04
Bring insurance information: If you have health insurance coverage, make sure to bring your insurance card along with you. The form may require you to provide your insurance details, including the policy number and the name of your insurance provider.
05
Arrive early: To ensure a smooth check-in process, it is advisable to arrive a few minutes early before your scheduled appointment. This allows you some extra time to fill out the form accurately and thoroughly.

Who needs Champlain Medical Urgent Care?

01
Individuals with non-life-threatening medical concerns: Champlain Medical Urgent Care is designed to offer prompt medical attention to individuals who are experiencing non-emergency symptoms or conditions that require immediate medical attention but are not life-threatening.
02
People seeking medical care outside regular office hours: Champlain Medical Urgent Care is a convenient option for individuals who require medical attention when their primary care physician's office is closed or unavailable. This includes evenings, weekends, and holidays.
03
Those in need of immediate care: If you have a medical concern that requires prompt attention but is not severe enough for the emergency room, Champlain Medical Urgent Care can provide immediate medical services without the extended waiting times typically associated with emergency departments.
Remember, it's always essential to consult with a medical professional to determine the best course of action for your specific situation. If you are unsure whether you need urgent care or emergency care, contact Champlain Medical Urgent Care or your primary care physician for guidance.
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Champlain Medical Urgent Care is a medical facility that provides immediate treatment for non-life-threatening illnesses and injuries.
Patients who visit Champlain Medical Urgent Care are required to provide their personal and medical information for filing purposes.
Patients can fill out the necessary forms at the facility or online before their visit to Champlain Medical Urgent Care.
The purpose of Champlain Medical Urgent Care is to provide convenient and timely medical treatment for minor health concerns.
Information such as patient's name, date of birth, insurance details, medical history, and reason for visit must be reported on Champlain Medical Urgent Care forms.
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