Your First Visit

You will be asked to complete one or more information gathering forms about you to help the doctors know you better.

    Demographic information.

    Questionnaire about your general health and previous medical history including a list of current medications.

    You may be asked to complete special questionnaires depending on the reason for your visit.

We request that you bring the following information to expedite your visit with us.

    X-rays, x-ray reports and any laboratory reports that pertain to your visit that may have been ordered by your primary care and/or referring doctor.

    A list of your current medications.

    Insurance identification

    Referral information, if needed, such as referral form or referral number that is issued by your insurance company.

    Additional Patient Information

If you are scheduled in advance, we will be happy to send the forms that need completed to help expedite your visit. Please request these forms from the appointment secretary.

INSURANCES

    We accept most major insurances and are affiliated with many major HMO and PPO plans. If we are not listed in your provider directory, you may contact our billing department for verification of our participation in your plan at 440-845-6458.

    Medicare participants are responsible for any deductible, and 20% of the approved amount is a secondary insurance does not pay or if there is no secondary insurance.

    Co-payments, as designated by the patient's insurance company, are collected at the time of service.


    S O U T H W E S T
    U R O L O G Y

    6900 Pearl Road
    Middleburg Hts., Ohio 44130
    (440) 845-0900

    970 E. Washington
    Suite 5C
    Medina, Ohio 44256
    (330) 725-0600
    Toll Free: 800-589-7460

    E-mail: southwest@southwesturology.com