NEW PATIENT INFORMATION
New Patient Forms
Use the following links to download forms that may be necessary for your appointment. Please print and complete the form. Please bring all completed forms to your appointment.
What to Bring to Your Appointment
Your insurance card
Physician referral forms, if required by insurance
List of prescriptions and/or over-the-counter medication, including dose and frequency
Information about your medical and surgical history
Recent x-rays or relevant records
Insurance and Payment Information
Tharian Urology 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.
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.