Brea Urgent Care will close at 6pm on Wednesday, November 22nd and be closed on Thursday, November 23rd. We hope you have a wonderful Thanksgiving!

Workplace Forms

Authorization to Treat Form

If you are sending an employee in to Brea Urgent Care for any sort of treatment, please complete this workplace form.

Download and Print Form

 

WorkComp Insurance Information

If you are sending an employee in to Brea Urgent Care for a workplace injury, please complete this form.

Download and Print Form

 

Commercial Driver Fitness Determination

If you are sending a Commercial Driver for a Medical Examination Report to determine fitness, please complete this form.

Download and Print Form

 

In order to release Health Care information, the following form must be filled out:

Authorization to Release Health Care Information