Completing the forms listed below in advance will facilitate your visit. Please note that we make every effort to streamline your appointment. With this in mind, we appreciate a 24 hour advance notice for ALL CANCELLATIONS. This will allow us to release the time and preparations made for your visit and/or procedures and allocate that time and preparations to other patients. Should you miss your appointment or provide late (<24 hours) cancellation notice, a fee of $50.00 will be invoiced. We appreciate your cooperation and understanding.
A PDF reader like Adobe Acrobat is required to open all forms.
The “New Patient Forms” are for both new patients and for established patients whose last appointment was 3 or more years ago. We request that you print and complete the 3-page set of New Patient Forms and fax them to our secure fax numbers. This will save you 10 to 15 minutes at the time of your appointment.
- Register or update your information online
- Download the Patient Registration Forms (4 pages)
- Patient Responsibility Disclosure
Our secure fax numbers are:
- (212) 734-7425
- (212) 861-7964
For new male patients over age 45: In addition to the above forms, please also download and complete the questionnaires below. Please make sure that you have read all of the information; if you have questions, you are welcome to address them with our staff.
- International Prostate Symptom Score (IPSS) questionnaire (1 page)
- Androgen Deficiency in the Aging Male (ADAM) questionnaire (1 page)
- Sexual Health Inventory for Men (SHIM) questionnaire (1 page)
Additional forms to be completed UPON REQUEST:
- Financial Policy (2 page)
- HIPAA Telephone Notification Consent Form (1 page)
- HIPAA Acknowledgement and Consent Form (1 page)
- HIPAA Disclosure (10 pages)
- Medicare Beneficiary Notice (1 page)
Your doctor will indicate to you which instructions you should review prior to your procedure.
- IVP (Intravenous Pyelogram) Preparation Instruction (1 page)
- Prostate Biopsy Instructions (1 page)
- Post-op Instructions for Pubovaginal Sling Surgery (1 page)
If you are undergoing any of the procedures listed below, please take the time to read the description of the procedure and what you can expect before, during and following.