Your First Appointment

Please plan to arrive at our office at least fifteen minutes prior to your first appointment. We will send you several forms when you make your first appointment, or you may use the links below to download the appropriate forms. Please complete these and bring them with you. (These forms help the physician to assess your condition and assists to determine the kind of treatment that is best for you.)

Please bring your insurance card(s) and any referral forms that you have received from your primary care physician. It is your responsibility to know if your insurance plan requires a referral for our evaluation.

Please bring any x-rays and/or reports from tests (if available) that may pertain to your condition or ask your physician's office to send this information to us before your visit.

Patient Forms

For your convenience, we have made several patient forms available online. You can access these forms and have them filled out before your appointment, using the links below. These forms are in PDF format.
[Help with PDF forms]

• Financial Policy
• Patient Registration Form
• New Patient Intake Form, Female
• New Patient Intake Form, Male

Billing and Payment for Services

We will bill your insurance provider for the services you receive at Urology Associates of DuPage. All co-pays or payments for services, when insurance plans are not applicable, are due at the time of service. We accept VISA/MC, personal checks, or cash. It is your responsibility to pay any outstanding balances in a reasonable time frame.

It is a policy of this office to assist you with the handling of your insurance claims. Our doctors participate in the Medicaare Program and accept assignment. We file both Medicare and secondary insurance claims for you.

If you have private group insurance we will file claims for you as long as we have your Assignment of Benefits on file.

There may be a nominal fee for copying records and completing forms.

Insurance

HMO programs always require referrals from your primary care physician. Be sure you have checked your program requirements before coming to your appointment. Our office is not able to call for referrals for HMO Programs. It is the patient's responsbility to obtain these referrals.

Some insurance carriers require pre-authorization before certain tests or procedures are performed. Our business personnel will work with you to assure that pre-authorization is obtained. If you fail to obtain pre-authorization for care we provide, you may be personally responsible for the charges incurred. If you have any questions about preauthorization, please call your insurer or our business department.

Prescription Refills

Our physicians will only authorize refilling of prescriptions that have been prescribed by us for a urologic condition. You may leave a message on our prescription refill line. Our nursing staff will authorize the refill through your pharmacy if appropriate. We will not refill prescriptions if you have not seen our urologist in over a year. Please call for your prescription before your medication runs out. Because the on-call physician doesn't have access to your records, refills can only be given during normal office hours.

Privacy Practices

Urology Associates of DuPage wishes to present a printable document outlining their privacy practices.

Visit them at www.hipaadocs.com to see all of their practice's HIPAA policies.