Med-East Medical Walk-In Center Forms

You can download the forms below and fill them out using your computer.

(Adobe PDF Reader required)

Company Information form


Download

Employer Consent form


Download

HIPAA Questionnaire 


Download

Presenting Problem form

Download
Med-East Medical Walk-In Center logo

Contact Med-East

  • Willimantic Office

    1703 West Main Street
    Willimantic, CT 06226
    860.456.1252
    Map/Directions

    Hours:
    8 AM to 6:45 PM, Mon-Fri
    10 AM to 3 PM, Sat & Sun

  • Tolland Office

    200 Merrow Road (Route 195)
    Tolland, CT 06084
    860.871.5452
    Map/Directions

    Hours:
    9 AM to 6:45 PM, Mon-Fri
    10 AM to 3 PM, Sat & Sun

  • Med-East Medical Walk-In Center is not a trauma facility. If you are seriously injured or ill, you should proceed to the Emergency Department at Windham Hospital. Most insurance accepted. Please call in advance to verify insurance acceptance. If we do not participate with your insurance, you will be required to pay at the time of service. All major credit cards accepted.