Medical clinic, urgent care physicians; Spokane, Washington.

Franklin Park Urgent Care Center

We are Here When You Need Us!

Online Documents

Select the desired document and download or print on your printer. Complete the document and bring it into the clinic. All documents are in MicroSoft Word format, except the New Patient Information form which is in PDF format.

	Employment Application Form

	Complete this form to apply for employment with the clinic. Mail, email, fax or bring in this application, a current resume and list of references to Franklin Park Urgent Care Center.

	Patient Medical Release Form

	Complete this form to authorize Franklin Park Urgent Care Center to release your medical records to another medical care provider or facility. Mail, email, fax or bring in the completed form to have your medical records released. Please allow us one week to send the records to the appropriate location.

	Notice of Privacy Practices (HIPAA Policy)

	This document describes how medical information about you may be used, disclosed and how you can get access to this information.

	Give brief statement of present medical problem

	If you have been seen in the clinic within the last three years complete this document before coming to the clinic. Bringing the document in will save you time and help you to see the doctor quicker. For your convenience, the document contains two exact copies of the form on one page (in case more than one family member needs to be seen). You need only to fill out 1/2 of the form for each person to be seen. If you have not been seen in the clinic within the last three years complete the New Patient Information form below before coming into the clinic.

	New Patient Information Form

	If you have not been seen in the clinic within the last three years complete this document before coming to the clinic. Bringing the document in will save you time and help you to see the doctor quicker.

Franklin Park Urgent Care Center

5904 North Division Street
Spokane, WA 99208-1026

Phone: (509) 489-1150

Fax: (509) 482-6010