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AFC Urgent Care Bedford

154 Great Road

Bedford, MA 01730

781-430-8161

At AFC Urgent Care Bedford, we're here for you! Follow our simple online registration to complete your visit
NOTE: If you are currently experiencing a medical emergency, please dial 911 or proceed to the nearest emergency room
AFC Urgent Care treats patients 12 months and older
But first, please make sure you don't need to call 911.

Please fill in additional patients.

The clinic has reached its limit for this visit reason today.

Patient First Name

Patient Last Name

Visit Day

Visit Time

Cell Phone Number

Date of Birth

Patient Birth Sex

Have you had direct contact with someone who has tested positive for COVID-19 in the last 14 days?

Please list any medications you are currently taking

In the last 14 days, have you traveled to a state considered to be high risk for COVID-19 infection?

Are you currently a smoker?

Have you ever been a smoker?

Have you received your 2023 -2024 Flu Vaccine?

Do you have any significant family medical history (first degree relatives)? If so, list here:

Color, make and model of vehicle in which you will be arriving to your appointment

I understand that if I am registering for an Immigration Physical ONLY I will be contacted by a member of the team to discuss pricing and to collect a non-refundable $200 deposit for the visit

I acknowledge that at the Provider’s discretion, my virtual visit may need to be transitioned to an in person visit based on the acute medical issue I am experiencing. If the Provider determines that I need to be evaluated in person, I agree to return to the clinic on the same day. I may also be required to go to the clinic for further testing, such as labs, x-ray or EKG.

Briefly describe your reason for visit

I acknowledge that if my reason for COVID19 testing is for Travel, work or school we are unable to process your visit through insurance and I will be charged $150

Is your reason for visit COVID19 testing?

Are you registering for an immigration Physical?

Is your reason for testing related to work, school, travel, social gathering?

I acknowledge that if my reason for COVID19 testing is for travel, work, school or social gathering we are unable to process your visit through insurance and will be charged $150

I acknowledge that if I decline an office visit with a licensed provider inside the clinic, I will be tested at the car-side with a molecular COVID19 test (PCR or Rapid) at a cost of $150

READ BEFORE CONTINUING: If you are symptomatic or exposed, have an appointment in queue #1 and would like to process your Rapid COVID19 test through insurance you must have an exam by a licensed provider. This exam means your visit be longer than just the time it takes to perform a nasal swab. There may be delays in your appointment time if there are emergencies or other urgent patients in the clinic. We appreciate your patience and understanding. If you prefer to experience a quicker visit with no examination, please select option #2 to pay for a COVID19 test ONLY, not processed through insurance.

Are you vaccinated for COVID19? If yes, how many doses of what vaccine did you receive?

Would you like to receive your flu vaccine during your visit?

AFC Urgent Care Bedford

154 Great Road

Bedford, MA 01730

781-430-8161

We may not have any appointments available, but we are open every day 8am-8pm so please feel free to walk-in instead!

Please fill in additional patients.

I have reviewed the information on when to call 911.