COVID-19 Vaccination

UrgentMED is currently vaccinating individuals 18 years of age and older.

If you are interested in being vaccinated, please follow the steps below.

  • Call (701) 232-9000 and speak with our vaccine coordinator to schedule an appointment (because vaccine vials need to be used in a short period of time and to reduce the chance for vaccine wastage, we are putting patients into specific time slots).
  • Download the four registration forms below and complete these prior to your arrival (this will make your visit more efficient and assist our staff in expediting patient flow).
  • Arrive a few minutes early for your appointment. Ifyou are unable to keep your appointment, notify us so we may move someone else into your time slot.

Forms to download, print and complete:

  • Patient Registration Form-pleasefill out the top portion with name and address information. You do not need to complete the insurance information, but bring a copy of your insurance card with you. Note,we may bill your insurance company an administrative fee for your vaccination, however, there will be no cost to you to be vaccinated, whether you have insurance or not.
  • HIPAA Notice of Privacy Practices Form- please read, sign and bring in the acknowledgment form on the last page.
  • Consent for Care/Privacy Practices Form- please read and sign the top two sections on Consent for Care and Treatment and Benefit Assignment. Again, we will vaccinate you whether you have insurance or not and there will not be a charge to you.
  • ND Department of Health Vaccine Administration Record- please complete the top box and be familiar with the rest of the form as you will complete it at the time of your vaccine visit.
Urgent Medicine Associates, 2020