Maui Urology
Maui Urology
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    • Home
    • About Us
    • Contact Us
    • Men's Health
    • Women's Health
    • Kidney Stones
    • Testimonials
    • FAQs
    • Patient Portal
    • Forms and Statements
    • Telemedicine
    • Urolift
    • Provider Links
    • Insurance Notices

  • Home
  • About Us
  • Contact Us
  • Men's Health
  • Women's Health
  • Kidney Stones
  • Testimonials
  • FAQs
  • Patient Portal
  • Forms and Statements
  • Telemedicine
  • Urolift
  • Provider Links
  • Insurance Notices

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 Policy form and the Communication and Records Consent. 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.

Forms

Patient Information (pdf)Download
Patient Intake Form Maui Urology (pdf)Download
Male questionnaire (pdf)Download
Female Questionnaire (pdf)Download
Financial Policy 2025 (pdf)Download
Communication and Records Consent (pdf)Download
Authorization to release records to Maui Urology (pdf)Download

Statements

New Patient Instructions (pdf)Download
Patient Rights and Notifications (pdf)Download
Privacy Practices (pdf)Download
Fee Schedule Ancillary Services 2025 (pdf)Download

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