Welcome! On your initial visit, please bring:
- Your insurance and identification cards
- Referrals from your primary care physician if required by your insurance provider
- List of drug allergies
- List of current medications (prescription or over-the-counter) including your name, dosage, and frequency
- All pertinent test results regarding your urological condition
- All pertinent X-ray and ultrasound images (on CD) and the corresponding reports
- Completed Patient Forms below
Prepare and Learn
While you are waiting for your visit. Please explore our website and read about your conditions that you may want to discuss with the doctors.
If you are a new patient to our practice, please print and complete the applicable patient forms below
We HATE paperwork but sadly we don’t have a choice. It takes most patients about 20-30 minutes to fill out all the forms and if you fill these out ahead of your visit, we may see you much faster. Thank you!
[ PDF Help]
Please write your name and date of birth at the top of EVERY page.
- Male New Patient Registration and Intake Form (PDF)
- Female New Patient Registration and Intake Form (PDF)
- SHIM Erectile Dysfunction Score Sheet (for all MALE patients) (PDF)
- Men – Prostate Symptoms (for all MALE patients) (PDF)
- ADAM questionnaire about symptoms of low testosterone (for all MALE patients) (PDF)
- Overactive Bladder (OAB) Symptom Quiz (for all FEMALE patients) (PDF)
- Language Assistance Services (PDF)
- No Surprise Act GFE Form (PDF)
- Standard Notice and Consent Documents Under the No Surprises Act Instructions (PDF)
- Notice of Privacy Practices (PDF)
- Forma Del Historial Del Paciente (PDF)
- Paquete De Registro De Nuevo Paciente (PDF)
- Cuestionario de indicio de sintomas de Prostata Larga (PDF)
Broward Urology Center providers are affiliated with the following hospitals:
We are providers for Medicare and most major insurance plans. We provide insurance billing. Please inquire with us as to whether you are still able to come to our office even if we are not on your insurance plan. We are able to see many patients as “out-of-network.” We will assist you in determining the benefits with your plan. Anything not covered by insurance will be your responsibility.
We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. When necessary, our staff will work closely with patients who require a payment plan.
If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at the phone number below.