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Insurance & Prices
Forms for registration, discharge notes, and medical records
Hours by department

You can handle payment at Burbank Urgent Care by either using health insurance or by using no insurance (meaning, you self-pay). We accept most major credit cards. Sorry, no checks accepted.

Use Health Insurance

Burbank Urgent Care accepts many PPO, EPO, and some HMO insurances. Please remember to bring your insurance card to to the clinic.

Depending on your insurance and if you have a deductible, we may mail you a paper bill after your visit. You can pay your bill here.

Be Self-Pay (Use No Insurance)

You can pay for Burban Urgent Care services if you do not have health insurance. We happily accept self pay patients.

View Health Insurances

View Prices

Burbank Urgent Care will require you to fill out some forms before treatment.

Registration Form

You have 2 ways to register at Burbank Urgent Care.

Option 1: Make a reservation. If you reserve your time online, then the reservation system will prompt you to give your demographic information and medical history. That means, you do NOT need to download this form.
Option 2: If you want to walk in, then you’ll be asked to fill out the clinic’s paper registration form. To save time, you can print, fill out this form and bring to the clinic. Of course, it’s also fine if want to just walk in and fill out the form once in the office

Los Angeles County Covid 19

If you think you have Covid and are coming in for Rapid or PCR testing, please complete and print out this form to bring in to the clinic.

Download Form

Get a Copy of Your Discharge Papers

If you came to Burbank Urgent Care, you may have received Discharge Notes from your provider at check out. Tip! The discharge notes is a sheet of paper that gives information about your diagnosis, medications prescribed, the body vitals, and any procedures. done.

If you need a copy of your discharge notes, please complete the form below. Sorry, no requests by phone.

Click here so you know what to expect after you fill out this form

Burbank Urgent Care will release medical records, billing records and X Ray images as long as the clinic has the patient’s written consent or authorization.

Provider or Health Facility

If you are a provider from a medical facility, please call our office to request records. We will get them to you generally the same day.

Patient or Attorney

If you are a provider from a medical faciloity, please contact our office to request records. We will generally send records same day

Patient Form

Attorney Form

Subpeana

All subpoenas or authorization to copy must be served to Document Management Services, Inc (DMS). Burbank Urgent Care is not authorized to accept service of any subpoenas. Download instructions

Instructions for Subpoenas

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