Patient Forms

General Forms

• File

  Non Discrimination Notice - Spanish
• File

  Non Discrimination Notice
• File

  Authorization to Discuss Financial Account Information
• File

  Who will be Accompanying Patient
• File

  Acknowledgement of Receipt of Privacy Practices
• File

  Advance Medical Directives
• File

  Patient Rights and Responsibilities
• File

  Out of Network Notice
• File

  HIPAA Privacy
• File

  Right to Receive a Good Faith Estimate of Expected Charges
• File

  Notice Regarding Patient Protections Against Surprise Billing
• File

  The Urocenter Investors (PDF)