Reason For Visit*
Terms & Conditions
I understand the online check-in is not to be used for life threatening conditions. I do not believe the patient’s condition is life threatening and understand if this is a true medical emergency, I should call 911 immediately.*
I consent to be contacted by email, and understand that sensitive, information may be contained in this email, and that using email contains certain risks.*
If you think you may have a life threatening medical emergency, call your doctor or 911 immediately.
*All Fields Required
We participate in most medical insurance plans. (We do not participate in Medicaid, Medicare or Tricare.)
© 2018 Five Star Emergency Room - .