Forms & Information
The information listed is helpful for new and existing patients, and will facilitate the completion of documentation prior to your appointment.
All forms require Acrobat Reader or similar program capable of displaying PDF files.
Patient Forms
For new patients, we request that you print and complete the 3-page set of New Patient Form. This will save you 10 to 15 minutes at the time of your appointment. Please ensure that you have read all of the information; if you have questions, you are welcome to address them with our staff.
New Patient Forms - (3 pages)
Financial Policy - (1 page)
HIPAA Telephone Notification Consent Form - (1 page)
HIPAA Acknowledgement and Consent Form - (1 page)
Medicare Beneficiary Notice - (1 page)
International Prostate Symptom Score (I-PSS) questionnaire - (1 page)
Androgen Deficiency in the Aging Male (ADAM) questionnaire - (1 page)
Sexual Health Inventory for Men (SHIM) questionnaire - (1 page)
Procedure Instructions
IVP (Intravenous Pyelogram) Preparation Instructions - (1 page)
Prostate Biopsy Instructions - (1 page)
Post-op Instructions for Pubovaginal Sling Surgery - (4 pages)
Ambulatory Instructions for Lenox Hill Hospital - (1 page)
Ambulatory Instructions for Lenox Hill Hospital on Same Day - (1 page)
Ambulatory Instructions for New York Hospital - (1 page)
Ambulatory Instructions for New York Hospital on Same Day - (1 page)
Procedure Descriptions
Understanding a Variocele - (3 pages)
Disclosures
Privacy Practices Notice - (1 page)