Alliance Urgent Care - Virtual Visit

Alliance Urgent Care

Virtual Visit

Closed

9:00am to 7:30pm MST

REASON FOR VIDEO VISIT

CHOOSE A DATE AND TIME:

HAVE YOU BEEN TO ALLIANCE URGENT CARE BEFORE?:

No

Yes

PATIENT INFO:

Patient first name

Patient last name

Year

Mobile number

Email address

HOME ADDRESS:

Street Address

Apt, Suite, etc (optional)

City

ZIP code

HOW DO YOU WANT TO PAY?

Insurance

Self-Pay

I have read, understand and agree to Solv Health’s Terms of Service, Financial Relationships, andPrivacy Policy.

I give my consent for the use of telemedicine in my medical care and have read, understand, and agree to these Terms

Bookings by Solv.

For emergencies please call 911