Northwest Suburban Urologists

Patient Information

• What to Bring to Your Appointment
• Patient Forms
• HIPAA/ Privacy Forms
• Patient Procedure Instructions
• Payment and Insurance Information

What to Bring to Your Appointment

• Insurance card
• Physician referral forms if required by insurance
• A list of current prescription or over-the-counter medications, including dose and frequency
• Pertinent information about your medical and surgical history
• Any recent x-rays or appropriate records you may have

Patient Forms

The following is a list of links to our downloadable patient forms. Please print and complete them before your appointment.

• Initial Patient Medications
• Patient Registration Forms
  • Patient History Form
  • Patient Information Form
  • Communication Waiver
• Permissions, Consents, and Responsibilities
• Financial Policy
• Credit Card Form

HIPAA/ Privacy Forms

• HIPPA
• Medical Authorization for Release of Medical Records

Patient Procedure Instructions

So that you may read or print patient procedure instructions 24 hours a day, we are posting instructions for many common procedures on our site.

• Cystoscopic Bladder Biopsy In-Office Procedure - Pre-Procedure Instructions
• Cystoscopic Exam - Post-Procedure Instructions
• GreenLight PVP laser procedure (for BPH)
  • GreenLight PVP Laser Pre-Procedure Patient Instructions
  • GreenLight PVP Laser Post-Procedure Patient Instructions
• Prostate Ultrasound and Biopsy
  • Preparation - Prostate Ultrasound And Biopsy
  • Precautions Following Prostate Biopsy
• TUNA procedure (for BPH)
  • TUNA Therapy Pre-Procedure Patient Instructions
  • Post-Procedure Patient Instructions For Office TUNA
• Vasectomy
  • Requirements for Obtaining a Vasectomy
  • Vasectomy Frequently Asked Questions
  • Pre Vasectomy Instructions For Office Procedure
  • Post-Operative Vasectomy Instructions

Payment and Insurance Information

Northwest Suburban Urologists, LTD, is a provider for Medicare and most major insurance plans. We provide insurance billing. 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. Questions regarding your coverage and benefits should be directed to your employer or insurance company.