Patient Forms

In an effort to help decrease your waiting time in our center, please fill out the applicable forms listed below prior to your visit with AFC Urgent Care in Englewood, CO.

Instructions: Click on the link below to save the Adobe PDF document. Open the saved file and type your information into the form and print the document.

  • Registration Form – All new and existing patients must fill out and sign the form for each patient visit.
  • HIPAA Statement – Review and keep for your records. Upon request, a copy can also be provided to you during your office visit.
  • Payment Notification Form – All new and existing patients must fill out and sign the form for each patient visit.
  • Medical Record Release Form – Complete the form and mail or fax your request to AFC Urgent Care.
  • Authorization to Consent to Medical Treatment of a Minor – Patients who are under the age of 18 years old and NOT accompanied by a parent or legal guardian cannot be treated in our center without this form completed and signed by parent or legal guardian. If you have questions concerning the form or our policy as it relates to medical treatment of minors please call us.


Mailing Address:

AFC Urgent Care – Englewood
901 W. Hampden Ave., Suite 103
ATTN: Medical Record Release
Englewood, CO 80110

Fax: 303-761-4099
ATTN: Medical Record Release

*Please allow 3 business days for processing*

For questions about any of the forms contained on this page, please contact us at 303-761-1699.