Patient Forms & Policies
Before your appointment with us, quickly and conveniently access patient forms from Urology Specialists in Sioux Falls.
To view the forms listed below, you will need to download Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.
- ASC Billing Notice
- ASC Notice of Rights
- Confidential Communication/HIPAA Privacy Practices
- New Patient Registration
- Patient Financial Policy
- Patient History and Medication
- Patient Insurance Questionnaire
Download Office Policies
- Patient No Show Policy
- Privacy Practices – HIPPA
- Release of Information (Disclosure Authorization)
- Right to Receive a Good Faith Estimate
We ask that you do not call the office with medication refill requests. Please call your pharmacy to fax us a request. Our fax number is (605) 336-7182.
Our nursing staff is available to answer your questions and address concerns Monday through Friday from 8:00 a.m. – 4:30 p.m.
Please leave your name, a phone number, and where you can be reached with the front office staff and a nurse will return your call. All calls cannot be returned immediately, but will be responded to in a timely manner. Messages received after 4:30 pm may not be returned until the next business day.