Check In Online 2 - Medex Urgent Care

Step 1 of 3

Who are you checking in to be seen?(Required)

Myself

Someone Else

Are you a new or existing patient?(Required)

New Patient

Existing Patient

Select an appointment date to pre-register, then walk in during business hours. Wait times may vary.

Mon-Fri 8:00am - 7:30pm

Sat-Sun 9:00am - 5:00pm

Date(Required)

Name(Required)

Date of Birth(Required)

Sex:(Required)

Male

Female

Undifferentiated

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone:(Required)

Driver's License:(Required)

Upload photos

Present in person

Photo of front of driver's license:(Required)

Max. file size: 256 MB.

Photo of back of driver's license:(Required)

Max. file size: 256 MB.

Full Name:

Phone Number:

Relationship to Patient:

Check In