To minimize delays and wait times, please download and complete the relevant forms below before your appointment. Print them out, fill them in, and bring them with you.
All forms are provided as PDFs. If they don’t open, download the free Adobe Acrobat Reader.
Male urology intake form
Complete this form before your first visit and bring it with you to save time at check-in.
Female urology intake form
Complete this form before your first visit and bring it with you to save time at check-in.
Bladder diary
Track your fluid intake and bathroom visits over 24–48 hours before your appointment. Helps your provider assess your bladder health.
Clear liquid diet
Sample menu for the clear liquid diet, typically required before certain procedures.
Cystectomy patient packet
Comprehensive information and instructions for patients preparing for a cystectomy procedure.
Hand assisted nephrectomy
Pre- and post-operative instructions for patients undergoing hand assisted nephrectomy.
Post transurethral prostate resection instructions
Recovery instructions and care guidelines following a transurethral prostate resection procedure.
Robotic assisted nephroureterectomy
Patient information and instructions for robotic assisted nephroureterectomy surgery.
Robotic partial nephrectomy
Instructions and information for patients scheduled for a robotic partial nephrectomy.
Robotic radical prostatectomy
Comprehensive pre- and post-operative guide for patients undergoing robotic radical prostatectomy.
General urology intake form
Complete this form before your first visit and bring it with you to save time at check-in.
Authorization to release medical records
Use this form to authorize us to release your medical records to another provider or organization.
Altrusa House medical partner referral
Referral form for lodging assistance through Altrusa House for patients and families during treatment.
FMLA & STD instructions
Instructions for completing Family Medical Leave Act (FMLA) and Short Term Disability (STD) paperwork, including the associated $25 completion fee.
FMLA & STD authorization for release of health information
Authorization form allowing Urology Associates of Green Bay to disclose your protected health information to your employer for FMLA/STD purposes.
Financial policy
Our payment and insurance policy, including information about co-pays, balances, and billing procedures.
Privacy notice brochure
How Urology Associates of Green Bay handles and protects your personal health information (HIPAA).
Need a document that isn’t listed here? Call us and we’ll send it to you directly.
Appointment policy: Urology Associates of Green Bay, SC takes pride in our patient’s healthcare needs for this reason; if you fail to show for a scheduled appointment, you will be billed $30.00 for that appointment unless a 24-hour notice has been given.