Patient Forms

Patient Forms

Save time at your visit by printing and filling out your patients forms before you arrive. Contact the office where your appointment is scheduled if you are not sure which forms you need to complete.

Adult New Patient Packet
Patient packet for new patients 18 years old or older.

Patient packet for new patients under 18 years of age.

Registration Form
Patient information for Northwest Urology.

Medical History Form (Adult)
Medical history for patients 18 years old or older.

Medical History Form (Pediatric)
Medical history for patients under 18 years of age.

Authorizations

Authorize Northwest Urology to share or receive medical records.

Authorization to Disclose Protected Health Information
Authorizes Northwest Urology to release medical records to another organization or provider.

Authorization to Request Medical Records
Authorized Northwest Urology to receive medical records from another organization or provider.

Notices and Information

Privacy, financial and other practices and information.

Notice of Privacy Practices
How Northwest Urology protects your medical privacy

Financial Policy
Billing and insurance information

Prep Sheets

What you should do before an appointment or scheduled medical procedure.

Needle Biopsy Sheet
Before a prostate biopsy using a biopsy gun and needle

Voiding Log
For helping diagnose incontinence or frequent urination