Forms/Info
There is always some necessary paperwork that must be completed by you so that we may care for you. This includes basic demographic information such as address and phone number in addition to health insurance information. We will also need you to fill out a detailed past medical history form so that we may know any contributing medical conditions which will assist in your care. These forms will need periodic updating by you so that we can be sure that we have up to date information, such as recent medical problems or new medications. We will do our best to minimize any unnecessary paper work.
In order to make this chore more convenient for you, we have most of these forms online for you to fill out in the privacy of your home without being rushed in the office waiting room. At the present time for us to comply with HIPPA privacy rules, you will need to print these form out after completing them online. We cannot accommodate this information in a secure fashion over the internet at this time. You can either bring the printed completed form in with you to the office or fax them to us if you have fax capability at your home or office.
In order to view the form, fill it in and print it out, you will need to have the latest Adobe Reader 9 on your computer. You probably already have it and may not be aware. It is a free program that comes on most computers because it has become an international standard for displaying and transmitting documents over the internet. If you do not have the latest version, you can easily download it for free by clicking here. Select your computer operating system (Windows or Mac OS) and click continue. Installation is self explanatory. After you have Adobe Reader, open the form on our site and you should be able to read and fill in the blanks right on you web browser. After completion, print the form by clicking on the printer icon in the upper left corner and bring in with you to the office.
Patient Information and Medical History
This form must be completed yearly so we can have accurate information and know of any changes in your other medical problems.
Drugs to Avoid Before Surgery
Some medications, both prescription and over-the-counter, are associated with an increased risk of abnormal bleeding with surgery. This link is to a list of drugs which have been noted to have such affects. It is only the most common offenders. Other medications not listed could also be a problem. If you are unsure, ask your doctor.
Urinary Symptoms Survey
Men Only - Please click on this link for the AUA Symptom Score form. Type in your name and date. Then print the form. After printing, circle the correct numeric answer (0-5) for each of the questions on the left. Please bring the completed form with you when you come for your appointment.
The AUA Symptom Score is a survey which helps your doctor assess the severity of your voiding (urinary) symptoms.