New Patient Registration and Forms

If you are new to our practice, welcome!

The information below is provided to expedite the registration process for new patients. Please read it carefully.

1. You must bring the following items to your first appointment:
   • Your insurance card
   • Your identification or driver's license
   • A referral from your primary care physician (if needed)
   Please be aware that if the requested information is not presented to our staff at the time of your visit, we may have to reschedule your visit to allow you to bring the information to us.

2. Please arrive 15 to 20 minutes prior to your first office visit to allow enough time to complete your registration.

Forms:
For your convenience, we have provided several forms to be completed prior to your arrival. You can download and print them out from this website, using the links below. For downloading/printing help, consult PDF Help.

All new patients must complete the following two forms:

• Patient Registration Form (PDF)
• CMUA Urology Patient Questionnaire (PDF)

In addition to the above forms, please choose the form below that best describes or relates to your medical condition for this office visit.

• Sexual Dysfunction Questionnaire (PDF)
• Incontinence Questionnaire (PDF)

Please complete the printed forms and bring them to your first appointment. If you do not have a way to print our forms at home, you may request them by calling our office at 301.725.8880. We will be happy to mail them to you.

Our Established Patients

"We hope to continue to serve you by providing the best urologic care in a compassionate and understanding manner by competent healthcare providers and supporting staff."
- Doctors Kishel, Applestein, Gessler, Rodriguez, Hawes and Nezu

The information below is provided to expedite the registration process for established patients. Please read it carefully.

It is your responsibility to provide our office staff with all current medical information regarding your health and insurance information at the time of your office visit. You will be requested to present:

• Insurance card
• Identification or driver's license
• Referral from your primary care physician (if needed)

Forms:
To expedite your visit with us, we have provided several forms you can download and print from this website, using the links below. For downloading/printing help, consult PDF Help.

All established patients must complete the following two forms:

• Patient Registration Form (PDF)
• CMUA Urology Patient Questionnaire (PDF)

• Sexual Dysfunction Questionnaire (PDF)
• Incontinence Questionnaire (PDF)
• Male Genitourinary Questionnaire (PDF)
• Female Genitourinary Questionnaire (PDF)

Please complete the printed forms and bring them to your appointment. If you do not have a way to print our forms at home, you may request them by calling our office at 301.725.8880. We will be happy to mail them to you.

Prescriptions

In most situations, we would be more than happy to call in your prescription to the pharmacy. It would speed up the process if you would have the following information ready for our staff:

• The correct spelling of your name
• Your date of birth
• A telephone number where you can be reached
• The pharmacy name and telephone number
• The name and dose of your medication, as well as how much you receive and how you take it
• If it is a refill, the RX number usually listed at the top of the bottle is also helpful.

We only ask that you give us time to pull your chart, give it to the doctor, and telephone it in to the pharmacist. In some cases, we may have you call the pharmacist and s/he can call the doctor directly.

Test Results

Depending on the laboratory and/or the type of test you have performed, it takes anywhere from a few moments to several hours for our office to receive results by fax or telephone. Some tests may even take days or weeks to receive.

Please have the following information available when calling our office for results:

• The name of the test(s)
• Where the test was performed
• The date the test was performed
• The name of the doctor who ordered the test

Referrals

Many of the managed care health insurance plans require you to obtain a referral before visiting a specialist. Other plans require no referrals. Each plan is different.

You should take it upon yourself to become educated about YOUR health insurance. You enter into the terms of your insurance contract with your insurance provider, NOT your physician. It is your responsibility to make sure you understand the terms of your coverage and the necessity - or lack thereof - of obtained referrals and what services are allowed or not allowed.

Your insurance carrier has entered into contracts with certain diagnostic centers for services. This may limit your options as to what lab or imaging center you can use. It is important for you to know who participates with your plan.

We are happy to assist you with your insurance, but cannot accept responsibility for knowing all of the details of your coverage. Please contact the customer relations department of your carrier. Typically, the number is listed on your card. They are far better prepared to answer questions regarding your coverage than our office staff.

IF YOU HAVE AN INSURANCE THAT REQUIRES A REFERRAL... it may be beneficial for you to request one as soon as you have scheduled your appointment with us. Some primary care offices take two weeks to process them. If you do not have a referral, there is the possibility that you will not be seen by our physician.

Co-Payments

Insurance policy dictates that co-pays be collected at the time of visit. Please check your policy for your co-pay amount and be prepared to pay at the time of service. For your convenience we accept cash, checks, VISA and MasterCard.

Punctuality

Striving to stay "on time" benefits us all. It decreases stress and makes us all more efficient. Office and surgical emergencies impact schedules and result in unpredictable waiting periods.

You can help by accurately and completely advising the scheduler why you are scheduling an appointment. The length of your appointment time is based on your discussion with that staff member. They operate under clearly-defined guidelines. If you schedule an appointment for a routine follow-up, and you then advise the doctor that a new problem has occurred in the last week while you are in the exam room, the schedule is impacted. Feel free to call and update our scheduler if you feel you will need more time with the doctor than you had originally planned.

Your patience is greatly appreciated.

Inclement Weather

A decision to close the office is not taken lightly. It is made at the highest levels, taking into consideration the safety of our patients and our staff.

We do not follow the local school closings. You will receive a telephone call from one of our staff members advising you that we have elected to close for the day. If you are unsure of the status of your appointment and have not heard from us, please feel free to contact the office. If the office is in fact closed, the answering service will pass along that information to you.

Weigh the necessity of your visit against the risk of the trip. Your well-being comes first, and we will be happy to reschedule your appointment for a later date. If you do plan to venture out, please use extreme caution, especially in the parking lots and sidewalks. If we are open, and you don't call, we can only assume you are planning to keep your appointment.

Holidays

The office closes for the following holidays:

• New Year's Day
• Good Friday
• Memorial Day
• Fourth of July
• Labor Day
• Thanksgiving Day and following day
• Christmas Eve and Christmas Day

Quality Assurance

We strive every day to provide the best possible urology care by caring for all of our patients, and meeting the needs of other healthcare providers. Sometimes processes in our offices may not meet your expectations. We want to hear from you if that is the case. Our office administrator will assist you with any of your concerns. Please call 301.725.8880.

Financial Information

To review your financial statement or any other financial matter pertaining to our office, please call and talk to one of our competent, courteous Billing Department personnel at 301.725.3582.

We accept Visa and Mastercard, check, or cash as forms of payment for co-payments and office fees.

Central Maryland Urology Associates, P.A.

3450 Fort Meade Rd., Suite 207 Laurel, MD 20724 [VIEW MAP] Phone: 301.725.8880 Fax: 301.725.3135

11085 Little Patuxent Pkwy., Suite 204 Columbia, MD 21044 [VIEW MAP] Phone: 410.997.1930 Fax: 410.992.1688

Columbia Urological Surgery Center
11085 Little Patuxent Pkwy., Suite 207
Columbia, MD 21044
[VIEW MAP]
Phone: 410.997.5422
Fax: 410.997.4359