Forms

Please bring to your appointment:

* Photo ID

* Your insurance card

* A list of all of your medications

* Any recent imaging/x-ray studies on a CD disc

Please print all 9 forms below and fill out at home prior to your appointment. This will speed up your appointment time.

1. New Patient Registration Form
2. Patient History Form
3. Patient History Form – Review of Systems
4. Assignment of Benefits / Right to Release Payment
5. Privacy Practices (4 forms)
6. Acknowledgement of Receipt of Notice of Privacy Practices

Our mission at Florida Urological Associates is to provide the highest quality of urologic care to our patients. We are dedicated to staying on the cutting edge of new and innovative procedures to best serve our patients and their families for generations to come.