Forms and Statements
Instructions for Forms
1. Please review ALL Forms and Statements below.
2. All new patients please fill out the Patient Information form and Intake form.
3a. All men fill out the Male questionnaire (AUA-SHIM form).
3b. All women fill out the Female questionnaire form.
4. All patients please review and sign the Financial and No-Show policy form. These are updated intermittently and you may be asked to sign and acknowledge receipt of the current version during follow-up visits.
The Consent to leave messages and the Authorization to release records are optional if needed.
You may bring these completed forms with you or send a copy in advance to expedite your visit. If you choose to send a form by mail, we recommend keeping a copy to bring with, in case of mail transit failure.
For telemedicine visits, you may either mail or fax the forms in advance or upload them via the telemedicine website at the time of your virtual check-in. We must have all necessary forms as above in order to facilitate your appointment.
