Patient Forms

To save valuable time, please download and complete the forms below. You may email them to [email protected] or print and mail them to our address above. Instructions are below.

New Patient Forms

Patient Forms Instructions

Adobe PDF forms contain fields that you may type in to complete the form. Once you have completed the form, you can save the form to your computer and then send it as an attachment to [email protected]

  1. Open the form by clicking the above image. (You will need to have Adobe Reader on your computer. You can download Adobe Reader for free from adobe.com)
  2. Fill out the forms by clicking blank fields and typing your information.
  3. Save the completed form to your computer by pressing “ctrl + s” or pressing the floppy disk icon.
  4. In your personal email client, compose an email to [email protected] with the subject “New patient forms submission”, attach the completed forms file, and send.
  5. If you have trouble filling out and emailing the digital forms, you may call our office and request printed forms in the mail. Alternatively, you may print the forms and mail them to our office at:

Urology Associates
1905 Glen Meade Road
Wilmington, NC 28403

Patient Information

Payment Policy

HIPAA Authorization

Medical Records Authorization

Wilmington Location

Address

1905 Glen Meade Rd.,
Wilmington, NC 28403

Southport Location

Address

4222 Long Beach Rd SE Suite B,
Southport, NC 28461

Monday  

9:00 am - 5:00 pm

Tuesday  

9:00 am - 5:00 pm

Wednesday  

9:00 am - 5:00 pm

Thursday  

9:00 am - 5:00 pm

Friday  

9:00 am - 5:00 pm

Saturday  

Closed

Sunday  

Closed

Contact Us

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Please do not submit any Protected Health Information (PHI).