Your Visit/Patient Forms

Please plan to arrive at our offices 15 minutes before your appointment time to complete the registration process. 

If your insurance requires a referral, please be sure to bring it with you to your appointment. Also, please bring your insurance card(s). 

To ensure that your physician has the information he or she needs to provide you with the highest quality care, please arrange to have any medical records or test results from other physicians sent over to the practice at least one week before your appointment. 

Fax: 212-987-4675 

Mail

Department of Urology 
Icahn School of Medicine 
5 East 98th Street Box 1272 
6th Floor 
New York, New York 10029 

Click here for Directions/Parking


Registration Forms

To save you time, please fill out our forms ahead of time and bring them with you:

Adult Patient Registration Forms

Adult Patient Registration Form [PDF]

Adult Patient and Family History Form [PDF]

Pediatric Patient Registration Forms

Pediatric Patient Registration Form [PDF]

Pediatric Patient Health Questionnaire [PDF]