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Patient Information

Hospital Affiliations | Your First Appointment | Patient Forms
Insurance and Payment Information | Privacy Practices

Hospital Affiliations

We are affiliated with the following medical facilities:

• Kremmling Memorial Hospital, Kremmling, CO
• Memorial Hospital, Craig, CO
• Pioneers Hospital, Meeker, CO
• Yampa Valley Medical Center, Steamboat Springs, CO

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

• Patient's insurance card
• List of current prescriptions and/or over-the-counter medication, including dose and frequency
• Information about patient's medical and surgical history (see forms below)
• Recent test results, x-rays, or relevant records
• Any applicable patient forms.

Patient Forms

All new patients of the office should fill out the following forms and bring them in on their first visit.
[ All files are "fillable" PDF files, which means you can type into them directly before printing them out. Click here for PDF help. ]

• Privacy practices and acknowledgment form
• Consent to treatment
• Patient history form
• Patient Information form

Please complete the following forms as well if applicable.

• Promissary Note - If you would like to set up a payment plan.
• Medical Records Release - Fax or mail this in.

Insurance and Payment Information

Urology Clinic, P.C., is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

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. It is given to all new patients, and a copy is available upon request.

Privacy practices and acknowledgment form [pdf]

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