Patient Forms

Patient Forms

Save time at your visit by printing and filling out your patients forms before you arrive. Contact the office where your appointment is scheduled if you are not sure which forms you need to complete.

Adult New Patient Packet
Patient packet for new patients 18 years old or older.

Registration Form
Patient information for Northwest Urology.

Medical History Form (Adult)
Medical history for patients 18 years old or older.

Authorizations

Authorize Northwest Urology to share or receive medical records.

Authorization to Disclose Protected Health Information
Authorizes Northwest Urology to release medical records to another organization or provider.

Authorization to Request Medical Records
Authorized Northwest Urology to receive medical records from another organization or provider.

Notices and Information

Privacy, financial and other practices and information.

Notice of Privacy Practices
How Northwest Urology protects your medical privacy

Financial Policy
Billing and insurance information

Prep Sheets

What you should do before an appointment or scheduled medical procedure.

Needle Biopsy Sheet
Before a prostate biopsy using a biopsy gun and needle

Voiding Log
For helping diagnose incontinence or frequent urination

COVID-19 Precautions

***Northwest Urology Update***

During this unprecedented time, we remain committed to the needs of our patients, and are actively monitoring the COVID-19 situation in our community. We assure you that your health and the well-being of our employees is always our top priority.

Due to the current situation with COVID -19, our office is encouraging telehealth visits for most appointments. We currently offer several telehealth options for your convivence. Please contact our office at 503-297-1078 for more information or login to the patient portal to communicate with your physician. If you need to be seen in our office, please take comfort in knowing that we follow social distancing and will only allow one caregiver to accompany you to your appointment.

For the safety of our employees, physicians and other patients, please reschedule your appointment if you are unwell or are experiencing any symptoms such as fever, cough, headache or shortness of breath. This office does not have test kits and is not equipped to handle the COVID-19 virus. Please seek your primary care physician for advice.