Request an Appointment Form

New Appointment
COVID-19 Testing, Telehealth Services, & More!

Check-In Online

Check-in online to speed up the process during your visit. We are also now taking walk-ins.

If you would like to schedule a telehealth visit please complete this form or give us a call.

Special Reminder: If you enter our clinic please make sure to have a mask on for the safety of our staff and yours. Thank you.
Select a Reason *
Reason For The COVID-19 Test *
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number: *
E-mail *
DOB *
Date Of Birth (MM/DD/YY)
How would you like to pay? *
Insurance Card Photo: Front Side *

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Insurance Card Photo: Back Side *

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Are you a new patient? *

Yes No
Photo ID: Front Side *

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Photo ID: Back Side *

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Preferred Pharmacy (If Prescribed A Medication) *
Select an Appointment Date *
Terms & Conditions *

I understand that my time spot could be delayed due to unforeseen circumstances, but that Clovis Urgent Care does everything possible to accommodate my requested time spot. There may be a short wait when you arrive.
Should be Empty:

New Appointment