PATIENT FORMS

 

Please download and print at home, then fill out the information on all pages.  Bring along the completed new patient packet to your first office visit for review.

 

Print all pages of the packet together or select pages individually:

 

NEW PATIENT PACKET (all 18 pages)

 

Patient Registration Form

 

Patient History Form

 

IPSS Form (Males 50 yrs & older ONLY)

 

Billing & Payment Policy

 

Red Flag Identity Theft Policy

 

HIPPA Privacy Policy 

 

 

Other important patient forms:

 

Initial Male Infertility Questionnaire (Males coming for an initial infertility evaluation)

 

MEDICAL RECORDS REQUEST FORM

 

PATH LAB SLIDE/MATERIAL RELEASE FORM

 

 

ABOUT YOUR VISIT 

FIND A PHYSICIAN 

MAKE AN APPOINTMENT 

NEW PATIENT PACKET

PAY YOUR BILL ONLINE

Male INFERTILITY Questionnaire 

 

 UROLOGY HEALTH OFFICE LOCATIONS

ABINGTON
1235 Old York Road
Abington, PA 19001
215-517-1100

 

BROOMALL

1974 Sproul Road, Suite 106

Broomall, PA 19008

610-259-3000

BRYN MAWR
245 South Bryn Mawr Avenue
Bryn Mawr, PA 19010
610-525-2515

 

 

HUNTINGDON VALLEY
1800 Byberry Road

Suite 1203
Huntingdon Valley, PA 19006
215-947-4105

 

MEDIA
1088 West Baltimore Pike

HCC II, Suite 2304
Media, PA 19063
610-744-2844

PAOLI
4 Industrial Boulevard

Suite 180
Paoli, PA 19301
610-525-2515

PHILA - CHESTNUT HILL

8815 Germantown Avenue

Suite 46
Philadelphia, PA 19118
215-242-8260

PLYMOUTH MEETING
400 Davis Drive, Suite 200
Plymouth Meeting, PA 19462

215-242-8260

 

WEST GROVE-CHESTER COUNTY
455 Woodview Road, Suite 230
West Grove, PA 19390

610-259-3000

WEST GROVE-JENNERSVILLE
1011 West Baltimore Pike
West Grove, PA 19390
610-869-6851

WYNNEWOOD
100 E. Lancaster Ave, East 361
Wynnewood, PA 19096
610-649-6420

 

CORPORATE OFFICE
140 W. Germantown Pike #250
Plymouth Meeting, PA 19462
484-530-0205

BILLING OFFICE
P.O. Box 1287
Blue Bell, PA 19422
 

       


 SURGERY CENTER LOCATIONS                                                                             UH PROSTATE CANCER CENTER

BROOMALL

1974 Sproul Road
Suite 104
Broomall, PA 19008
610-600-9935

HUNTINGDON VALLEY

1800 Byberry Road

Mason Mills II, Suite 1204

Huntingdon Valley, PA 19006

215-947-4105

PAOLI

4 Industrial Boulevard

Suite 175
Paoli, PA 19301
484-320-7700

CANCER CENTER

400 Davis Drive

Suite 200

Plymouth Meeting, PA 19462

610-825-2151

 

 

Urology Health Specialists, LLC is not affiliated with Universal Health Services, Inc. or UHS of Delaware, Inc.