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Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

Download Patient Forms

To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at Please bring your completed forms with you to our office at the time of your visit.

Office Policies

Cancellation Policy and No-Show Policy

Appointments can be made by calling our office during normal business hours.

We are a busy office and wish to respect our patients’ and doctors’ time. If you need to change or reschedule an appointment, it must be done 24-hours prior to the scheduled appointment or earlier. Failure to reschedule or change the appointment in a timely manner or failure to show for the appointment could result in a $50 Cancellation or No-Show fee. This fee will need to be paid as a deposit for any future visits and can be applied towards the patient responsibility upon attendance of the next appointment.

After Hours & Emergency Care

If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call physician is available 24-hours a day, 7-days a week.

Prescription Renewals

Prescriptions are renewed during normal office hours. In some instances, we may require that the patient be seen in our office prior to medication renewal. Please allow the office 5 business days.


All office visits are payable at the time of service. We accept cash, checks, and most major credit cards and debit cards. Please contact our billing office should you have any financial questions or concerns.

Privacy Policy

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Your Health is our #1 Priority.

Request your appointment today with Urologic Physicians and Surgeons, PA!