Email  E-mail This

Patient Information

Patient Forms

Using the links below, you can download, print and complete the appropriate forms before your appointment.

The following will be provided to all new patients:

What to Bring to Your Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

  • Your insurance card
  • Physician referral form, if required by your insurance provider
  • A list of medications, including the dose and frequency
  • Information about your medical and surgical history
  • Recent x-rays or other test results related to your condition

Insurance and Payment Information

Capital Urology, Inc., 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.

Hospital Affiliations

  • Riverside Methodist Hospital - Columbus, OH
  • Dublin Methodist Hospital- Dublin, OH
  • Mount Carmel St. Ann's - Westerville, Ohio
  • Knightsbridge Surgery Center - Columbus, OH
  • American Kidney Stone Management - Columbus, OH

Capital
Urology

Please visit our Patient Forms section to print out and complete the forms prior to your visit.

This will help expedite being seen by one of our providers at your next office visit!