Your First Visit

Please be sure to bring your insurance card,http://edit2.healthcommunities.com/index.php referral if necessary, identification, and a list of medications to your office visit. Please complete your medical history and demographic forms in advance of your first appointment (available online below).

New Patient Forms

If this is your first office visit with us, please print and complete the forms below. Or, if you prefer, please arrive 15 minutes before your appointment to allow time for completion of these forms in our office. To view and/or print the forms, click on the links below:

• Patient Registration Form
• Health History Form
• Financial Statement
• Prostate Symptom Form
• AUA Symptom Score (AUASS) and Quality of Life (QOL) for Men
• Sexual Health Inventory for Men (SHIM)
• Incontinence Impact Questionnaire/Urogenital Distress Inventory
  (male and female)

Insurance

We accept most major insurances. You are responsible for anything not covered by your insurance.

Hospital Affiliations

• Parkland Medical Center
• South New Hampshire Regional Medical Center
• St. Joseph Hospital in Nashua
• Holy Family in Methuen
• Elliot in Manchester
• Lawrence General Hospital