Patient Resources

Patient Forms

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Acknowledgment Receipt of Privacy Notice
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Annual Health History
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Authorization for Release of Protected Health Information
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Authorization to Fax Documents
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Delegation of Authority Affidavit
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ED Registration Packet
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HIPAA Notice of Privacy Practice
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HIPAA Limitations and Restrictions of Protected Health Information
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Infertility Registration Packet
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IPSS-Form BPH Scoresheet
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Patient Registration Packet
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Vasectomy Registration Packet
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Release of Medical Records
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Vasectomy Insurance Sheet
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Ward of State Authorization
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Billing and Insurance

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Your Rights and Protections Against Surprise Medical Bills
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Managed Care Insurance Plans
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Good Faith Estimate
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Patient Rights and Responsibilities

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Patient Bill of Rights
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Patient Support

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Balanitis and Balanoposthitis
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Calcium Phosphate Stones and Renal Tubular Acidosis
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Care of Foley Catheter
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CT Scan Information
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Estrogen Replacement for Urinary Incontinence
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Female Self-Catheterization
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Hyperuricosuric Calcium Oxalate Kidney Stones
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Instructions for the use of a Pessary
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Low Testosterone (Hypogonadism)
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Male Self-Catheterization
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Precautions Following Prostate Biopsy
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Post-Operation ESWL Instructions
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Post-Operation Stent Placement Instructions
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Post-Operation Scrotal Surgery Instructions
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Post-Operation Surgical Wound Care
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Regimen for Atrophic Vaginitis
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Sacral Neuromodulation
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Self Cather Cleaning
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Suppressive Antibiotic Treatment Instructions
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Suprapubic Catheter
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Testicular Hypofunction Care Pathway
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Urethral Stricture
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