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Colton Urgent Care

1181 Mt. Vernon Ave.

Colton, CA 92324

909-639-8800

En Español

Welcome to the online check-in for Colton Urgent Care.

Please provide your information below and we’ll reserve your place in line, allowing you and your family to wait more comfortably at home – or wherever is convenient – until your estimated visit time.

Arrival times are estimates only. For your convenience, you will receive updates and reminder text messages about your urgent care visit once you’re in the queue.
To schedule a COVID-19 Vaccine please click the link below. After clicking the link and answering questions, you will see our clinic with available appointments and brands.
Click here for COVID-19 Vaccine Appointments

But first, please make sure you don't need to call 911.

Select a reason

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

Patient First Name

Patient Last Name

Visit Day

Visit Time

Sex

Cell Phone Number

Patient Type

Date of Birth

Sex

Would you prefer to get your prescriptions here for $15?

Have you traveled outside of the U.S. in the past 14 days or been exposed to someone with the 2019 Corona Virus?

Do you have a fever, cough, congestion, or shortness of breath?

Payer

Insurance Name

Insurance Subscriber (ID) Number

Insurance Group Number (Enter NA if you don't have one.)

Patient Address

Patient City

Patient Zip

Patient State

Parent/Guardian Name

Parent/Guardian DOB

Preferred Pharmacy (Name and Street)

Symptom(s)

I acknowledge the SoCal Emergency Medicine Consent for Treatment and Privacy Policy and Telemedicine Consent

How did you hear about us?

Did you select the reason for visit above as COVID-19 Vaccine?

We are currently following strict guidelines from CDPH and San Bernardino County for administration of vaccine.You certify you are in phase 1A, Tiers 1, 2, or 3, and will bring verification to registration.

The following information is required by the state to receive the vaccine:

Race

Ethnicity

Occupation

____________________________________________________________

Do you have any of the following symptoms in the last 10 days: fever, (>100.4F), chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new altered sense of taste or smell, sore throat, congestion or runny nose, nausea, vomiting or diarrhea?

Do you have a serious allergy to ANY medications, food or latex (e.g. eggs, gelatin, thimerosal, neomycin, gentamicin, etc.)?

Have you ever had a serious reaction or fainted after receiving any vaccination?

Have you received passive antibody therapy (monoclonal antibodies or convalescent serum) as treatment for COVID-19?

Have you received another vaccine in the last 14 days (other than the first COVID Vaccine dose)?

Have you tested positive for COVID-19 in the last 2 weeks?

Do you have a medical condition or take medication(s) that may weaken your immune system?

Are you pregnant or breastfeeding?

County

Are you willing to participate in a paid research trial?