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Forms

To help expedite your visit to Playa Marina Urgent Care Center, below are forms used for your office visit.  Depending on what type of visit you are in need of, you can download the forms and bring to your office visit. 

  • All patients must fill out the patient registration form.
  • If you have been injured on the job, please use the Authorization for Treatment form.  If you are an Employer, please use the Company Enrollment form and bring to your office visit..
  • For those who are wishing to travel, please fill out the Patient Travel Form and bring to your office visit. 
     

 


Any additional questions, please do not hesitate to contact the center directly at (310) 827-3700.