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What to Bring to Your Appointment Your insurance card Physician
referral forms, if required by insurance List of prescriptions and/or over-the-counter medication,
including dose and frequency (see form below) Information about your medical and surgical
history (see form below) Recent x-rays or relevant records Completed
patient forms (see form below)
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 NEW PATIENT FORMS
NEW
PATIENT FORMS: At Urology Consultants we understand your time is valuable. These are
our New Patient Information Forms. Filling this out in advance will speed your way through the registration process and get
you in to see the doctor sooner! We offer two ways to complete forms. Fill out the forms online
and then print to bring with you to your appointment Print off forms, fill out by hand and bring
with you to your appointment
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To view and print these forms Adobe
Acrobat Reader is required.
Please CLICK HERE to install the free Acrobat software direct from Adobe. |
PATIENT FORMS
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To view and print these forms Adobe
Acrobat Reader is required.
Please CLICK HERE to install the free Acrobat software direct from Adobe. |
Insurance and Payment Information Urology Consultants is a provider for Medicare and most major insurance plans,
and provides insurance billing. You are responsible for charges that are not covered by your insurance, at the time of your
appointment. Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff
will work with patients to set up a payment plan. If you have questions regarding billing or which insurance plans
we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed
to your employer or insurance company.
Questionnaires When viewing a questionnaire in Adobe Acrobat Reader, the text might appear somewhat fuzzy;
this is normal (the questionnaire will print out clearly). To print, just click on the printer icon in the Adobe Reader toolbar
above the document. Once you have the Adobe Acrobat Reader installed (see below), click on these links to view and
print the following questionnaires:
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To view and print these forms Adobe
Acrobat Reader is required.
Please CLICK HERE to install the free Acrobat software direct from Adobe. |
Privacy Practices Notice of Privacy Practices for Urology Consultants This notice describes how medical information about you may be used and disclosed and how you can get access
to this information. Please review it carefully.
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