AFC South Philadelphia Patient Forms
CALL US TODAY | (215) 964-9250
Register Online
Save time in the waiting room and register online or walk in today! Register Now
Register OnlinePatient Forms at Urgent Care and Walk-In Clinic in South Philly, PA
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. You can also register in advance by clicking here.
Download or Print, Fill out the form and bring back to the clinic.
Registration Form
Registration Form For Returning Patients
Registration Form For Occupational Medicine/Workers’ Compensation
HIPAA Notice Form
HIPAA Notice Form in Spanish
After you sign in, the front office personnel will request:
- Insurance Card
- Photo ID
- Co-Pay (if applicable)
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CALL US | (215) 964-9250
Don't wait to get the medical attention you need.
CALL US TODAY | (215) 964-9250
