Notice of Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information.

Appointment Information

If you are a new or existing patient, please make sure you bring the following to your appointment:

• Insurance card
• Referrals (if required by your insurance company)
• X-rays that our physicians have ordered for you
• A list of medications that you are currently taking
• Any co-payments that are required at the time of your visit (if applicable)

Patient Forms

You can print out the forms needed for your appointment using the links below. If you have any questions about the forms, please telephone the office. Complete the appropriate forms and bring them to your appointment. [printable/PDF page help]

• Medical history form [PDF] - all new patients
• Adult male genitourinary form [PDF] - for all new male patients
• Adult female genitourinary form [PDF] - for all new female patients
• Men: How healthy is your prostate? Take the International Prostate Symptom Score quiz to find out. If your score is Moderate to Severe, we recommend you contact your urologist and bring the completed quiz to your appointment.

Urology Specialists, P.C.

Main office:
1579 Straits Turnpike, Suite 2A, Middlebury CT 06762
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10 Main St., South, Southbury, CT 06488
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