Radiation Therapy Registration Form

Thank you for accessing our Radiology Therapy Registration form for Southern Urology.

Providing this information online before your visit will help ensure a more timely check-in. Please be sure to complete this at least 5 days prior to your scheduled office appointment.

In addition to completing this online form, some other information to know:

  • Please bring your insurance card(s) and drivers license to show at time of check-in
  • Please bring bottles – or an updated list – of any and all medications you are currently taking
  • Since we need a urine sample for most new patients, please arrive to your appointment with a full bladder so that we may obtain this for our lab at the start of your visit.
  • If you were referred to us by another provider, and there are medical records that would be pertinent to your visit (such as lab results, imaging scans, = physician or hospital notes, etc.) please contact your referring doctor, hospital or imaging center to make sure those records are sent to our office before your appointment.

Thank you again for taking the time to complete this form.