Patient Resources

Patient Forms

Using the links below, you can download and then print the necessary forms for your appointment. Please bring the completed forms to your appointment.

• Patient Registration and Financial Policy Form
• Patient Medical History Form
• Male Urology Questionnaire
• Privacy Notice

Articles of Interest

• No Needle Anesthesia for the Scalpel-Free Vasectomy
• BPH - Benign Prostatic Hypertrophy
• Peyronie's Disease
• Kidney Stones

What to Bring to Your Appointment

• Your insurance card
• Physician referral forms, if required by insurance
• List of prescriptions and/or over-the-counter medication, including dose and frequency
• Information about your medical and surgical history
• Recent x-rays or relevant records

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Insurance and Payment Information

Arizona Center for Vasectomy and Urology is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for charges that are not covered by your insurance, at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. When necessary, our staff will work with patients to set up a payment plan.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

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