Arkansas Urology toll-free:
877-321-8452
1300 Centerview Drive
501-219-8900 | Little Rock
3401 Springhill Drive, Suite 345
501-945-2121 | North Little Rock
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Preparing for your Appointment
Remember that it is important to always tell your doctor information that relates to your health, even if it makes you feel embarrassed or uncomfortable. Be prepared to explain to your doctor what issues and problems you are having. Prepare for your appointment in advance by writing down any questions you may have for your physician. Make sure to get these questions answered when you meet with your doctor, along with any other questions that may come up during your appointment. You may even want to bring someone along to help you ask questions and remember the answers.
Items to Bring
- An up-to-date “health history” list
- Any medications you are taking or a list of those medications, including dosage instructions
- Completed patient information forms
- Insurance cards
- Insurance co-payment
- Insurance referral if needed
- Medical records
- X-ray films, ultrasound discs and accompanying reports
- If you have had lab work done at another doctor’s office, please be sure we have a copy of it prior to your appointment.
Downloadable Forms
Select the appropriate form from the following list. Fill out all of the the forms for your category completely and bring them with you to your appointment.
6-Month Update Forms - 6 Month Update Form – Dr. D’Anna
- 6 Month Update Form – Dr. Langford
- 6 Month Update Form – Dr. Jones
- 6 Month Update Form – Dr. Bozeman, Dr. Brizzolara, Dr. Claybrook, Dr. Coussens, Dr. Diaz, Dr. Fraiser, Dr. Goodson, Dr. Kuhn, Dr. Logan, Dr. Mooney, Dr. Moore, Dr. Stallings
Female New Patient Forms - Female New Patient Registration – Dr. Brizzolara
- Female New Patient Registration – Dr. Diaz, Dr. Kuhn
- Female New Patient Registration – Dr. Bozeman, Dr. Claybrook, Dr. Coussens, Dr. D'Anna, Dr. Fraiser, Dr. Goodson, Dr. Jones, Dr. Langford, Dr. Logan, Dr. Mooney, Dr. Moore, Dr. Stallings
- New Patient Referral Information
- Authorization to Release Health Information
Male New Patient Forms - Male New Patient Registration – Dr. Brizzolara
- Male New Patient Registration – Dr. Diaz, Dr. Kuhn
- Male New Patient Registration – Dr. Bozeman, Dr. Claybrook, Dr. Coussens, Dr. D'Anna, Dr. Fraiser, Dr. Goodson, Dr. Jones, Dr. Langford, Dr. Logan, Dr. Mooney, Dr. Moore, Dr. Stallings
- New Patient Information
- New Patient Referral Information
- Authorization to Release Health Information