What to Bring to Your Appointment

If visiting the clinic for the first time, please print and fill out the patient information questionnaire:

• HIPAA Form (New Patients)
• Authorization for Release of Protected Health Information (Existing Patients)

Forms for Patients of the Georgia Lithotripsy and Laser Center

• Patient Pre-Op Questionnaire
• Advance Directive
• Patient Rights for Signature
• Cystoscopy Informed Consent Form
• Circumcision Informed Consent Form

Other items you should bring are:

• Your insurance card
• Physician referral forms, if required by your insurance company
• List of medications, including the dose and frequency
• Information about your medical and surgical history
• Recent x-rays or other test results related to your condition

Insurance and payment information

The Urology Clinic is a Medicare provider and we accept most major insurance plans and provide insurance billing. You are responsible for charges that are not covered by your insurance at the time of your appointment.

Please note your insurance company may require a co-payment at the time of your appointment. If necessary, our staff can work with patients to set up a payment plan.
If you have questions regarding billing or insurance plans, please call the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.