These are PDF documents - when you click on the form name, a new browser window will open, print the document, when you close this new window, you will see the list of forms again, please select and print all the forms we have asked you to for, in the same manner - fill them out and bring them with you when you visit us!

If you do not have the "Adobe Reader" Click HERE to get it, it's free

*New Patient Information

*New Patient Medical History

*Health history update (if your last visit was more than a year ago)


*AUA Symptoms (for male patients)

*Patient Assessment (for females only)

*Pain Questionnaire (only for patients with interstitial cystitis or pelvic pain)

*Sexual Function Assessment

*Neurotransmitter Assessment

*Metabolic Assessment


*Financial Policy

*Explanation of fees

*HIPAA Form (read and keep copy for your records)

*HIPPA CONSENT (sign acknowledging you have read the HIPPA form above)

*ABN (Advanced beneficiary notice for medicare patients only)

*Medical record release