New Patient Forms
Welcome to our Practice
We desire to make your first visit as smooth as possible. By completing these forms off our web site you will enable us to better serve you in a more timely matter. As a new patient you will need to download the forms listed below. If you are 12 years old or older please download the Adult New Patient Packet. For children under 12 years old you will download the Pediatric New Patient Packet. If you are seeing our Urologist (Dr. Couillard) then download the Urology New Patient Packet. If you have already completed your paperwork, we still recommend that you arrive approximately 15 minutes prior to your scheduled appointment time. It is also important to bring the following to your appointment:
- Any medications that you are taking, including Herbals and Vitamins-we recommend placing them in a plastic zip lock bag.
- Previous medical records (if available) as well as immunization records.
- A photo ID and your insurance card if you have insurance that you would like us to bill-check our insurance page to see who we are contracted with. Urology is the only specialty that has a contract with Hill's Physicians and Tricare-United Healthcare Military West. If you have an HMO please be sure that your authorization referral from your PCP has been secured.
- Payment for your services-this might be a copay or a deductible. We do collect an estimated deposit if your deductible has not yet been satisfied for the year.
Our physicians look forward to serving you in all your medical needs!