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We understand and appreciate the confidence this choice presents. At Lubbock Urology Clinic, we strive to provide state-of-the-art urologic services in a caring and comfortable environment. To assist us in providing the best service possible, we request the following:
- Arrive 15 minutes prior to your scheduled appointment time.
- If your insurance requires it, obtain a referral and/or authorization from your primary care provider in time for your scheduled appointment. If you do not obtain a referral and/or authorization, your appointment may be rescheduled.
- Bring medical records, prior x-ray films or x-rays on CD Rom, and any diagnostic test results.
- Please also provide us with a list of any medications you currently are taking.
- Your co-payment and/or deductible are due at the time of service. If you are unable to pay your co-payment and/or deductible, your appointment will be rescheduled.
- A scheduled appointment means that this time is reserved only for you. We request that if you cannot make your appointment that you give us 24 hours advanced notice. As a courtesy, we will remind you of your appointment the day before it is scheduled. If an appointment is missed without giving the office notice, a $25.00 charge will be billed to your account. This is an administration fee, not a charge that will be billed or paid by your insurance carrier. Future appointments will not be made until this balance is settled. We also request 24 hours advanced notice to reschedule an appointment.
Please complete your patient registration forms in advance. When you arrive at our office, present these completed form along with your insurance card and one form of identification to the receptionist.
New Patient Paperwork
- Financial Responsibility and Privacy Acknowledgement.pdf
102K Download
- Medical Release Form.pdf
108K Download - New Patient Worksheet.pdf
106K Download - Registration Form.pdf
75K Download
Privacy and HIPAA Notices
Have a question? Call us at: (806) 771-0077