AFC Pinellas Park Patient Forms
CALL US TODAY | (727) 201-8585
Patient Forms at Urgent Care and Walk-In Clinic in Pinellas Park, FL
To speed up the check-in process with American Family Care, please click on the Registration Form below, complete all the information, and bring the completed form in with you.
Registration Form
HIPAA Notice Form
HIPAA Notice Form in Spanish
After you sign in, the front office personnel will request:
- Insurance Card
- Photo ID
- Your payment share for your visit. (Copay or Coinsurance)
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CALL US | (727) 201-8585
Don't wait to get the medical attention you need.
CALL US TODAY | (727) 201-8585
