PATIENT FORMS

Urology Specialists of Ohio

PATIENT FORMS

Thank you for choosing the Urology Specialists of Ohio. Your care and well-being are our primary concerns, and we want your stay to be as comfortable as possible. Please call us if you have any questions at (937) 342-9260

PATIENT FORMS

Thank you for choosing our group of doctors and staff for your Urology needs.  In order for us to better serve you, below is a checklist of things to know and bring to your first appointment.  If you do not have the paperwork filled out prior to your appointment, please arrive 15 minutes early to complete in the office.  If you do not have the paperwork filled out prior to your appointment time then your appointment will be rescheduled to another date.

If you are not able to produce the appropriate identification cards we will not be able to see you at Urology Specialists of Ohio.

  • Review of Symptoms
  • Patient Demographics
  • Complete, sign and date our Financial Policy.
  • Complete, sign and date the patient Information Sheet.
  • Complete, sign and date the patient History sheet.
  • Complete Male Quiz, if sent in packet.
  • Bring your current insurance card.
  • Driver License or other government issued photo ID.
  • Utility bill or other correspondence showing current residence if the photo ID does not show your current address.
  • Please be prepared to supply your social security number.  We use this to verify identity.

Be prepared to pay your co-pay (and deductible if not yet met).  This can be paid with cash, check, VISA, MasterCard, Discover, American Express, or debit card.  If you are self-pay, be prepared to pay 100% of your balance due on your account.

If you have insurance that was not reported to us at the time your appointment was scheduled, please call with that information before your appointment.

If a referral is required by your insurance company, it is your responsibility to obtain it from your family doctor.  We must have it at the time of your visit or you cannot be seen.

If you are LATE for your appointment, you may need to be rescheduled.

PLEASE CALL IF YOU ARE UNABLE TO KEEP YOUR APPOINTMENT.

If you have any question, please feel free to call us.

Thank You,
Doctors and Staff at Urology Specialists of Ohio.

Patient Forms with Urology Specialists of Ohio in Springfield Ohio Mid Page

Thank you for choosing our group of doctors and staff for your Urology needs. In order for us to better serve you, below is a checklist of things to know and bring to your first appointment. If you do not have the paperwork filled out prior to your appointment, please arrive 15 minutes early to complete in the office. If you do not have the paperwork filled out prior to your appointment time then your appointment will be rescheduled to another date.

Urology Specialists of Ohio has been a committed part of the Springfield community for more that 10 years, and now serves Springfield, Beavercreek, London, Xenia, and Urbana striving to improve the medical community, with excellence in all areas of urology.

Our goals are to provide state of the art medical treatment for patients with genitourinary problems. We provide this in the most compassionate and cost effective way possible. We take pride in providing excellent care with attention to detail and respect in a friendly atmosphere.

FOR WOMEN

FOR MEN

For Men with Urology Specialists of Ohio in Springfield Ohio

PATIENT FORMS

Patient Forms with Urology Specialists of Ohio in Springfield Ohio

APPOINTMENT REQUESTS

Appointment Request with Urology Specialists of Ohio in Springfield Ohio

Come and visit

We look forward to your visit. be assured that your great health is our focused passion. click below to see our 5 locations. 

LOCATIONS

Contact

Phone

(937)  342-9260

Mail

info@usooh.com

Address

Business Location:
1164 E. Home Road
Springfield, Ohio 45503