Patient Forms and Pre-Appointment Information
For new patients, filling out our forms before your visit will help streamline your check-in process, and provide you with more time to ensure the information is accurate and legible.
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. (Many computers already have this installed, so you may try clicking a form first to see if it opens). After downloading Adobe Reader, just click on the form to view and print.
If you are not able to print the form, you may call to request that we mail you a blank copy prior to your visit, or stop by the office of your scheduled appointment to pick up a copy.
If you are unable to bring a competed form you your visit, we request that you come to your visit with (at a minimum) a list of your current medications and allergies, your insurance card(s), and a list of any relevant prior treatments from other providers.
- Urologic Patient Forms (Southern Urology division)
- General & Oncologic Surgery Patient Forms (Surgical Specialists of Lafayette division)
- Radiation Therapy Patient Forms (Dr. Shumadine / Lafayette Diagnostic & Radiation Therapy)
- CT Patient Forms (Lafayette Diagnostic & Radiation Therapy Center Dvision)
Scheduling Your Visit
To schedule an appointment, please call our offices directly. A listing of contact numbers can be found on our locations page.
Please let us know if you have a preference with respect to location, provider or time of day. Be sure to check with your insurance plan to see if you are required to have a referral from your primary care provider prior to seeing one of our physicians.
Getting Ready for Your Visit
In order for us to provide the best care for you, it is important that you bring the following items to your visit:
- Completed Patient Forms available to print from this page
- Any and all x-rays, CTs or lab records from other groups or hospitals that would pertain to your visit with us
- Your Insurance Cards (primary and secondary, if applicable)
- Medical records from prior visits that you think may be helpful
If for some reason you cannot print or pick up the Patient Forms available on this page, please take some time to collect, document and bring to your visit:
- A list of your current medications (if any)
- A list of your current allergies (if any)
- Information about what treatments, medications and/or surgeries you have had in the past (including dates) with other providers