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New Patient Information
Please take a moment to download and print out our new patient form and bring this completed form with you to your appointment.

• New Patient Form
• Notice of Privacy

Along with the form, please bring:

• Form of photo id (license, etc.) in accordance with “Red Flag Rules” required by the Federal Trade Commission
• Current insurance card(s), including secondary insurance, if applicable
• Any labs or medical records given to you from referring doctor

Be sure to contact your Primary Care Physician for a referral to our office (and bring the referral form as appropriate).

Thank you for choosing our practice. Our mission is to provide excellent urologic care and superior customer service. We welcome you to the practice and count on your feedback as to how we deliver on our stated mission.

Wills Surgery Center Patients
For patients that would like to use the Wills Surgery Center for procedures, please download and complete the following two forms (Wills Health Survey, Wills Informed Consent) and fax back to Attn Surgery Schedules, Urologic Surgical Associates of Delaware at (302) 836-5662.

• Wills Health Survey
• Wills Informed Consent
• Will Map and Directions

As a service for our patients who are unable to arrange transportation to the Surgery Center, the Center will provide transportation by sedan for the nominal fee of $10.00 roundtrip. The driver may be picking up more than one patient in your area, which could prolong your trip to the Center, your stay at the Center and your return home. One family member or friend may accompany you in the sedan. (A responsible adult must accompany you to the Center and stay with you the first 24 hours after surgery). The $10.00 fee will be collected by the receptionist when you arrive at the Center.