Patient Forms & Resources

PATIENT RESOURCES & INFORMATION

About Your Visit

What should you bring to your appointment at Michigan Urology

At Michigan Institute of Urology, patient care is our number one priority. We will work with you to schedule an appointment with the physician and location of your choice. If that physician is not available, we will suggest another qualified member of the group for you to consider.

It is important to our physicians that all of your questions are answered at the time of your visit. Please prepare for this by arriving at least 15 minutes prior to your appointment to fill out the necessary paperwork (you can print the forms from this website to allow you plenty of time to accurately fill them out prior to your appointment). You will need to bring the following information with you to your appointment:

  • A picture ID such as a drivers license or passport
  • Your health insurance card / information
  • A referral, if required by your insurance carrier. If you have a HMO, you must have a referral for each visit
  • Your copay / deductible required by your insurance carrier
  • The name and number of your referring physician and / or your primary care physician
  • A copy of your medial records and related imaging studies relevant to your current health care concern (from your primary care physician or referring physician)
  • A list of all medications you are taking, including the dose
  • A list of your questions /concerns
  • A friend or family member to take notes and to help with questions

Patient Forms (Downloadable PDF Packs)

Forms included in Adult Pack:

  • Adult Patient Information Form
  • HIPAA Policy
  • HIPAA Form
  • Financial Policy

Forms included in Pediatric Pack:

  • Pediatric Patient Information Form
  • HIPAA Policy
  • HIPAA Form
  • Financial Policy

Paying Your Bill

The office will process your credit card payment within 3 business days. You will receive a response once the payment has been processed. You will also be contacted if there should be a problem with the transaction.

Click here to pay your bill.

Downloadable Patient and Procedure Forms

If you prefer to download, print and complete our office forms, we have provided all the forms below:

New Patient Office Forms

Procedure Instructions Forms

Billing & Insurance Information

Please note that participating arrangements with the following health plans and insurance carriers are always in a state of flux, be sure to contact your provider or call the billing office at the Michigan Institute of Urology, P.C. for specific information regarding your plan.

Health Plans

  • Aetna (all plans)
  • All Blue Cross / Blue Shield of Michigan
  • American Family Care
  • Beaumont Employee Health Plan
  • Blue Care Network
  • Blue Choice
  • CAPP Care / Beech Street
  • CareAmerica
  • Care Choices HMO
  • Champus / Tricare
  • Choice Care
  • CIGNA
  • CIGNA/Equicore-PPO
  • CIGNA/PPO
  • CompPro PPO (Worker’s Comp)
  • DMC Care
  • ETHIX Group (inclusive of NGS, Family Health Plan, Great Lakes)
  • EXCELL
  • Family Health
  • First Care HMO
  • First Health (w/Referral)
  • First Health (formerly PHCS)
  • Health Plan of Michigan
  • Health Plus
  • Health Source
  • HAP
  • HAP Senior
  • MCARE
  • MCARE Senior Plan
  • Medicare
  • Medicare Blue
  • BS Medicare Advantage
  • BCN Medicare Advantage
  • CIGNA Medicare Advantage
  • BS Medicare Plus Blue
  • Medview-PPO
  • Mercy Health
  • Mercy Health Preferred Choices MCARE
  • Multiplan
  • Oakwood Employee Health Plan
  • Omnicare
  • One Health Plan (formerly Great Western)
  • PHCS
  • Preferred Health
  • Preferred / Choices PPO
  • PPOM
  • ProAmerica
  • Railroad Medicare
  • St. John Smart Plan
  • Teamsters
  • Ultimed
  • United Health
  • USA HealthNetwork
  • Wellness Plan