We want you to get the most value and time savings from your appointment. Please bring the following items to your appointment and present them at check in. If we have incomplete information your appointment may need to be rescheduled.
New Patient forms
You can choose from two options here; complete the new patient forms and submit them online OR print each form, fill them out and bring them with you to your appointment.
- Option A: Please click here to complete the forms online.
- Option B: To download a copy of each form and fill it out by hand, please click each of the links below. Print and fill out each form.
Patient Demographic Form
Patient History Form
Past Medical History
Review of Systems
Financial Payment Policy
Additional Items That May Be Required (when applicable)
- Any lab, ultrasound exams and/or x-rays pertinent to your visit with us. You will need to bring the films or disk, as well as the radiologist’s reports. Ask for your x-rays to be checked out to you for your doctor’s appointment as well as copies of the reports.
- Most recent PSA. Males forty years or older must have current PSA if you have not had one in the last 12 months.
- A urine specimen for most appointments is required. Be prepared to provide us with a urine specimen upon arrival. If you have difficulty providing a urine sample in the office, stop by and we can provide a cup to obtain a specimen at home. Please refrigerate the sample until appointment time. It should be no more than an hour or two old.
- Your medications. We need to have the name, the number of times a day, and the milligram dose of your medications. Please bring a list of your medications or the actual medications with you. Please include all vitamin and herbal supplements.
- A referral from your doctor if required by your Health Plan. Most health plans no longer require a referral to a specialist. If your Health Plan does require a referral and you do not have one at the time of your appointment, we will be happy to see you, however, charges will be due at the time of service.
- Your Health Plan ID card. If we are not participating providers with your Health Plan, payment in full is due at the time of service. If you are not sure, please call your Plan prior to your appointment. You will be financially responsible for all services not covered by your insurance.
- Payment for services rendered not covered by your Health Plan. We accept cash, check, VISA, MasterCard or Discover. Co-pays and deductibles are due at time of service.
Thank you for attending to the above issues. This will allow you to get as much information, value and time savings from your visit with the doctor. Many of the above requirements are by HMO’s and Managed Care.
As a courtesy to other patients waiting for appointments, and to our physicians and staff, Please call us at least 24 hours in advance of any appointments that you cannot keep. If you have any questions regarding your appointments, please feel free to call us at 505-872-4091.