Forms - Village EC

Forms

Here are three of our patient forms that we have you fill out with your contact and medical information. You can download them and bring them in with you so you don’t have to spend time filling them out while you’re here. At Village Emergency Centers, we have taken the steps to reinvent the way emergency and urgent care is provided.

Patient Sign-In Sheet

 

Patient Rights and Responsibilities

 

Assignment of Benefits and Consent for Treatment

 

What We Treat

  • Abdominal pain
  • Allergic reactions
  • Altered mental status
  • Asthma and breathing problems
  • Bone setting and splinting
  • Bronchitis
  • Burns
  • Cold treatment
  • Complete pediatric care
  • Chest pain and heart issues
  • Dehydration
  • Flu treatment
  • Foreign body removal
  • Head injuries
  • Overdoses
  • Pain control
  • Pneumonia
  • Rashes
  • Insect bites and stings
  • Seizures
  • Sinusitis
  • Lacerations
  • Sprains and broken bones

Pediatric Treatments

  • Cold and flu
  • Asthma attacks
  • Abdominal pain
  • Ear infections
  • Allergies
  • Lacerations
  • Burns
  • Conjunctivitis (pink eye)
  • Infections
  • Orthopedic injuries
  • Broken bones and sprains
  • And More