Forms 2017-12-04T22:31:08+00:00

Patient Resources & Forms

We look forward to meeting you on your first visit to our office. During this time, we will help you get acquainted with our office and learn about your urology treatment. We understand that each patient’s treatment is different, and we promise to give you the personal attention you deserve. We also know that your time is a precious commodity, so we have our Patient Information and Office Policies forms here for you to download and complete for your first visit with our office.

Patient Visit Forms:

Patient Registration

Patient Registration (Spanish)

HIPPA Privacy

HIPPA Privacy (Spanish)

HIPPA Privacy Practices Release

HIPPA Privacy Practices Release (Spanish)

Male Patient History

Male Patient History (Spanish)

Female Patient History

Female Patient History (Spanish)

Patient Follow Up Form

Patient Follow Up Form (Spanish)

LOCATION

OFFICE HOURS

Monday (for bookings only) 9:00am – 5:00pm
Tuesday 8:00am – 11:00am
Wednesday 7:30am – 11:00am
Thursday 8:00am – 6:00pm
Friday 7:30am – 4:00pm
Saturday Closed
Sunday Closed
BOOK AN APPOINTMENT NOW

Bookings for the MonaLisa Touch cannot be
taken online.
 Please call 516-627-6188 ext. 7015 
to schedule an appointment.

MEET DR. GIRARDI

MONALISA TOUCH LEARN MORE