NEW PATIENT ONLINE REGISTRATION
PATIENT PDF FORMS:
• New Patient Registration Form
• Established
Patient Medical
Update
• Authorization for Release of Protected Health Information
UROLOGY PARTNERS, PA
200 3rd Avenue W.
Suite 210
Bradenton, Florida 34205
phone: 941.792.0340
fax: 941.794.2251
LAKEWOOD RANCH Location:
Lakewood Ranch Professional Ctr
8946 77th Terrace East
Lakewood Ranch, Florida 34202
phone: 941.792.0340
fax: 941.794.2251
Urology Partner Patient Forms
Urology
Partners understands the complexity of medical care. Our goal of achieving
the best medical care starts with accurate and up-to-date information.
To expedite this process, you can preprint our standard forms and complete
them prior to your office visit. (See form
links below or to the upper right.) NOTE: The Forms CANNOT be completed
online; they must be printed and brought with you to your appointment.
You will need Acrobat Reader to view and print the office form PDFs.
To download the free Acrobat Reader for your operating system, click
here: get.adobe.com/reader/otherversions/
Also, bring an accurate list of medications (with dosages), prior urologic records, and most recent X-Ray, CT, MRI or Ultrasound studies to your visit.
A call to our medical records department (Dial 941.792.0340, then enter extension 1322.) can help you find out if your records have been received by our office from your physician.
Office Forms
If you are a new patient to Urology Partners, or have not seen one of our physicians for over two years, you will need to complete all of the following forms. To open a form just click the one you want below:
- New Patient Form—ONLINE Registration
- New Patient Registration Form—PDF version to print out
- New Patient Medical History—PDF version to print out
- Established Patient Medical Update—PDF version to print out
- Privacy Authorization—PDF version to print out
- Authorization
for Release of Protected
Health Information —PDF version to print out
If you are encountering issues opening any of the forms, do not hesitate to contact our office at 941.792.0340 and someone will be happy to assist you.
What to Bring to Your Appointment
If you are a new or existing patient, please bring the following items to your appointment:
- Your Insurance card
- Referrals (if required by your insurance company)
- X-rays that physicians have ordered for you
- A list of medications that you are currently taking
- Any co-payments that are required at the time of your visit (if applicable)
- Office forms (See links above if you prefer to fill them out before you arrive.)
