New Patient Guide
Springfield Urology.

New Patient Guide

Dear Patient,

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 Springfield Urology.

  • Complete, sign and date the patient Information Sheet.
  • Complete, sign and date the patient History sheet.
  • Complete, sign and date our Financial Policy.
  • 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 Springfield Urology.

 

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