Appointment and Upload – #SOUTHERNFLARECARES

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(912) 445-5520
(912) 445-5520

Southern Flare Urgent Care Center.

100 Timber Trail Rd. Richmond Hill, GA 31324

Telephone: (912) 445-5520

Appointment Upload Form

Your health, your future, your time.

Name *

First

Middle

Last

Date of Birth (DOB) *//

Is This For A Walk-In Visit or TeleMedicine Visit? *

Walk-In
Telemedicine

Photo ID and/or Insurance Card? *

Photo ID
Insurance Card
Not Now
Both, Photo ID and Insurance Card

Upload for EXPRESS Registration and Insurance Verification

Upload Photo ID (License) AND/OR Insurance Card HERE

Click or drag files to this area to upload. You can upload up to 4 files.

EXPRESS REGISTRATION: Save Time. Get Insurance Verified Online and Shorten Registration Process by Uploading Your Photo ID (License) AND/OR Insurance Card.

Did You Upload Photo ID or Insurance Card?

Does The Address On Your Photo ID Match The Address The Insurance Is Under?

Address *

Address Line 1

Address Line 2

City

State

Zip Code

If Photo ID has no address or address on Photo ID (License) differs from address insurance is under please input address(es) here.

Cell Phone # *

Primary Phone Number

Name

REGISTER ONLINE and use code: #SOUTHERNFLARECARES

Get $10 off your VISIT

New Patient Registration

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