Forms

For your convenience, North Bay Urology has made the following forms available online. Please print and fill out all applicable forms and present them at the reception desk when you arrive for your first office visit.

New Patients

  1. Acknowledgement of Privacy Practices (English | Spanish)
  2. Financial Policy (English)
  3. Medication Policy (English)
  4. New Patient Registration (English)
  5. Health History Form (Female | Male)
  6. Notice of Privacy Practices (English | Spanish)

Current Patients

  1. AUA Symptoms Score (English Only)
  2. Clear Liquid Diet Guidelines (English | Spanish)
  3. Fleet Prep Kit Instructions (English | Spanish)
  4. Medical Records Release Request (English Only)
  5. Surgery Instructions Sheet (English | Spanish)