Patient Forms & Policies
Before your appointment with us, quickly and conveniently access patient forms from our practice.
Appointment Request
Complete our online appointment request form and someone from our urology clinic will reach out. Your request will be processed within 24 hours, during normal business hours. If you do not receive confirmation of your request within 48 hours, please contact our urology clinic by phone.
Download Patient Forms
Please bring your completed forms with you to our urology clinic at the time of your visit. To view the documents listed on this page, you will need Adobe Reader.
- Registration Form
- Health History
- Assignment of Benefits
- Financial Policy
- HIPAA Privacy Consent
- Notice of Privacy Practices
Office Policies
- Appointments. Appointments can be made by calling our urology clinic during normal business hours.
- After Hours & Emergency Care. If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call physician is available 24 hours a day, 7 days a week.
- Prescription Renewals. Prescriptions are renewed during normal office hours. In some instances, we may require that the patient be seen in our office prior to medication renewal.
- Financial. All office visits are payable at the time of service. We accept cash, checks, and most major credit cards and debit cards. Please contact our billing office should you have any financial questions or concerns.
Billing & Insurance
We participate with most local and many national insurance plans. However, it is your responsibility to understand whether your insurance has limits on the doctors you can see or the services you can receive. If you provide complete and accurate information about your insurance, we will submit claims to your insurance carrier and receive payments for services. Depending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts.
Please contact our billing office or call your insurance carrier should you have questions.