Patient Forms

New Patient :

What to Bring to your appointment:

• All necessary referrals – you must contact your insurance to determine if a referral is needed
• A list of all your medical problems and previous surgeries
• A current detailed list of your medications
• List of any allergies
• Any previous medical records pertaining to your condition (i.e. – Emergency Room records, X-rays, Lab tests, previous urologist’s notes, previous operative reports, etc )

Forms:

• New Patient Demographics Forms
• New Patient History Form
• New Patient Medical and Physician Form
• Privacy Policy
• Financial Policy
• Complete packet of all above forms

Medical Records:

• Medical Records release form

In office Procedures: 

• BCG Therapy
• Biofeedback
• Cystoscopy with Bladder Biopsy
• Foley or Catheter Care
• Kegel Exercises
• Penile Injections / Trimix – Information
• Penile Injections / Trimix - Instructions
• Prostate Biopsy
• Self Catetherization Male
• Self Catherization Female
• Urodynamics instructions
• Uroflow instructions
• Vasectomy scheduling instructions
• Voiding Diary
• Zometa instructions
• Pad Weight

Surgery Instructions:

• Post-operative Female Urethral sling instructions
• Post-operative Cystocele Instructions
• Post-operative Rectocele Instructions
• Post-operative Combined Cystocele and Rectocele Instructions

 

• Post-operative Bone Anchor Male Sling instructions (InVance)
• Post-operative Non-Bone Anchor Male Sling instructions (Advance)

• Post operative Radical prostatectomy instructions
• Post-operative laser prostatectomy instructions
• Brachytherapy or Prostate seed implantation instructions
• Post-operative penile implant surgery instructions

 

• Post-operative Ureteroscopy instructions
• Post-operative percutaneous stone surgery instructions

Dietary Recommendations:

• General dietary recommendations for stone formers
• Low Oxalate Diet
• Low purine diet