Patient Forms

Patients can often save time on their first appointment by completing or at least reviewing forms in advance.

New patients (or those who have not visited one of our physicians for more than one year) please:

  • Bring your insurance card(s).
  • Bring a list of medications you are currently taking.

 

Welcome packet – general

Download, print and complete ALL forms in this Welcome Packet. This will save time when you come for your appointment.

Patient Welcome Packet

 

To view individual forms from the Welcome Packet, click on each item below:

Registration Form

Notice of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices

Financial Policy

Research Information Form

Nondiscrimination Notice – The Urology Group

Language Assistance Services – The Urology Group

Nondiscrimination Notice – The Urology Center

Language Assistance Services – The Urology Center

 

To open these documents you must have Adobe Acrobat installed on your computer. Click here to download it now.

 

Nursing Homes Only

To make appointments for your residents more efficient and productive, please take a few moments to complete the forms in this packet and send them prior to the patient’s office visit.

 

Welcome Packet – Nursing Home Only

 

Additional Forms

Patient History Do not fill out this form unless instructed by office.

Research Information Form

Bladder Diary

Bladder Diary Instructions

Bladder Symptom Tracker

Vasectomy Insurance Information

IPSS Score Form

Virtual Assistant

Virtual Assistant

How may I assist you today?

I need help with ‘Directions & Hours’
(Please select a location from the list below)
I need help with ‘ Billing Questions’
(Please select an option below)

I need help with ‘Billing Questions’

What number should I call to pay my bill?

If your bill is from The Urology Group, please call (513) 841-7474 to pay your bill.

If your bill is from The Urology Center, please call (513) 841-7475 to pay your bill.

I need help with ‘Making, Rescheduling or Confirming an Appointment’

If you would like us to call you to set up an appointment, please click here to request a call back.

If you would like to call us, please call
513-841-7400
to speak with a representative.
Our hours are:

Monday-Friday: 7:30am – 5:00pm

I need help with ‘Questions About Test Results’

please call us at:

513-841-7400

Our hours are:

Monday-Friday: 7:30am – 5:00pm

I need help with ‘Medication Refills’

please call us at:

513-841-7400

Our hours are:

Monday-Friday: 7:30am – 5:00pm

I need help with ‘Returning a Call from the Office’

please call us at:

513-841-7400

Our hours are:

Monday-Friday: 7:30am – 5:00pm

I need help with ‘A Copy of My Medical Records’

please call us at:

513-841-7400

Our hours are:

Monday-Friday: 7:30am – 5:00pm