University Hospitals Logo

Urologic Surgeons

Patient Forms | Hospital Affiliations | Your First Appointment
Insurance and Payment Information | Privacy Practices

Patient Forms


Using the links below, you can download, print and complete the appropriate forms before your appointment.
[Need help opening/printing PDF forms?]

Hospital Affiliations

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

Insurance and Payment Information

Urologic Surgeons is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

HIPAA Notice of Privacy Practices [PDF]