Patient Forms & Resources | Bloomington, IL | Premier

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(309) 663-9424

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Physicians
Conditions We Treat
Treatment & Procedures
Forms
Contact & Locations

Patient Forms for Your Urology Visit

Healthcare worker in blue scrubs writing on a clipboard at a desk with a small dish nearby

Doctor examining a patient’s chest in a bright clinic

Patient History Form

Patient Demographics Form

Healow App Setup

Financial Policy

HIPAA Release Form

Men 40 and Over

Medication List

Pre-Surgery Forms.

CYSTOSCOPY WITH POSSIBLE BIOPSY FULGURATION

TRANSURETHRAL RESECTION OF BLADDER TUMOR

URETEROSCOPY LASER LITHOTRIPSY STONE EXTRACTION AND URETERAL STENT

CVAC STEERABLE URETEROSCOPIC RENAL EVACUATION WITH POSSIBLE LASER LITH

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

PERCUTANEOUS NEPHROLITHOTOMY

URETERAL STENT PLACEMENT OR EXCHANGE

TRANSURETHRAL RESECTION OF THE PROSTATE

AQUABLATION THERAPY OF THE PROSTATE

PROSTATIC URETHRAL LIFT

ROBOTIC LAPAROSCOPIC PARTIAL NEPHRECTOMY

ROBOTIC LAPAROSCOPIC RADICAL NEPHRECTOMY

ROBOTIC RADICAL PROSTATECTOMY WITH POSSIBLE PELVIC LYMPH NODE DISSECTI

SIMPLE PROSTATECTOMY

SPERMATOCELECTOMY EPIDIDYMAL CYST EXCISION

PENILE PROSTHESIS PLACEMENT

ARTIFICIAL URINARY SPHINCTER PLACEMENT

RADICAL CYSTECTOMY WITH URINARY DIVERSION AND POSSIBLE PELVIC LYMPH NO

ROBOTIC LAPAROSCOPIC RADICAL NEPHROURETERECTOMY WITH BLADDER CUFF

RADICAL ORCHIECTOMY

SCROTAL EXPLORATION WITH DETORSION AND BILATERAL ORCHIOPEXY POSSIBLE

URETHRAL DILATION AND OR DIRECT VISION INTERNAL URETHROTOMY

SUPRAPUBIC CATHETER PLACEMENT OR EXCHANGE

CYSTOSCOPY WITH INTRADETRUSOR BOTULINUM TOXIN INJECTION

SACRAL NEUROMODULATION TRIAL AND IMPLANTATION

TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

TRANSPERINEAL MRI TARGETED AND OR SYSTEMATIC PROSTATE BIOPSY

INTRAVESICAL BCG THERAPY

INTRAVESICAL CHEMOTHERAPY SEQUENTIAL GEMCITABINE DOCETAXEL THERAPY

ROBOTIC LAPAROSCOPIC PYELOPLASTY

VARICOCELECTOMY

MALE URETHRAL SLING PLACEMENT

GREENLIGHT LASER VAPORIZATION OF THE PROSTATE

TRANSOBTURATOR VAGINAL SLING AND CYSTOSCOPY

Questions about your forms? Call our Bloomington, IL, office at 309-663-9424.

Home
Physicians
Conditions We Treat
Treatment & Procedures
Forms
Contact & Locations

Home
Physicians
Conditions We Treat
Treatment & Procedures
Forms
Contact & Locations

CONTACT INFORMATION

(309) 663-9424

(309) 663-6350

1401 Eastland Drive, Suite B Bloomington, IL 61701

BUSINESS HOURS

Mon - Fri: 8:00 am - 5:00 pm
Sat - Sun: Closed

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