Patient Forms

  • Authorizations to Use or Disclose Protected Health Information
    For routine release of health information

PDF

  • Authorizations for Electronic Communication
    For Release of Identifiable Information by Video/Tele-Conference or Audio-Conference – do not use for E-mail correspondence – see below.

PDF

  • Online form for Email and Other Media
    Use only this form to authorize Email correspondence. It can also be used for video- and audio-conferencing. You will be redirected to an outside website. Click here.
  • Authorization for the Use of De-Identified Health Information for Publication and Educational Purposes

PDF

US NEW AND WORLD REPORT BEST HOSPITALS BADGE. IT IS A GOLD SHIELD WITH THE WORDS BEST HOSPITALS WRITTEN IN BLACK AT THE TOP. A BLUE BANNER WITH THE WORDS US NEWS AND WORLD REPORT IN WHITE. BELOW THE BLUE BANNER ARE THE WORDS NATIONAL WITH UROLOGY ON THE NEXT LINE. THE DATE 2020 - 21 IS AT THE BOTTOM IN WHITE.

Ranked as the #17 urology program in the nation by U.S. News & World Report