What to Bring to Your Appointment
- Your insurance card(s)
- Any co-pays, deductibles, co-insurances or balances that may apply are all due at the time of service
- Your drivers license or photo ID
- A list of current prescription or over-the-counter medications you are taking, including dose and frequency
- Pertinent information about your medical and surgical history
- Any pertinent x-rays or records you may have
- If your insurances require a referral, you must contact your PCP to obtain referral prior to making an appointment
Patient Forms
For your convenience, please print and complete the appropriate forms listed below before your office visit.
- Patient Information- Pg.1
- Patient Information- Pg.2 & 3
- Financial Agreement
- Medications
- Laboratory/Imaging/Pathology Policies
- Authorization for Release of Medical Records
- Medical Information Authorization Form
- Notice of Privacy Practices
Payment and Insurance
Urology Associates of Norwalk is a provider for Medicare and most major insurance plans. We provide insurance billing. Anything not covered by insurance will be your responsibility.
We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. When necessary, our staff will work closely with patients who require a payment plan.
If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at 203-853-4200. Questions regarding your coverage and benefits should be directed to your employer or insurance company.