Patient Registration formThe physicians and staff at West Alabama Urology Associates are honored and privileged to be able to care for your urological concerns. We will do our utmost to assist you in returning back to and maintaining good health.
Get Ready for Your First Appointment
Upon your first appointment with West Alabama Urology, please bring the following:
- Your insurance card
- A list of all your current medications
- Completed information for new patients form
Please come into the office 10-15 minutes early so we are able to copy your insurance card(s) and verify the information you provided.
New Patient Forms
Patient Medical History
AUA Symptom Scorer
This score helps us to understand the level of your enlarged prostate condition.
We request that you review our payment guidelines and help us with timely payments of your insurance co-pays and account balance. Our office staff will be happy to inform you of our office and hospital financial assistance plans so that a suitable payment arrangement can be organized. We will treat all patients with equal respect and care no matter what your financial status.Patients With Medical Insurance
Co-payment is to be paid in full at the time of your appointment. If the copay cannot be paid then the appointment will need to be rescheduled. Our office staff will be happy to inform you of our office and hospital financial assistance plans so that a suitable payment arrangement can be organized.Patients With Private Pay
A down-payment will be expected of at least $100 at the time of your office visit. Dependent on the level of care you require, additional costs from the visit may be billed. Your payment balance and financial payment plan will be reviewed with you prior to your next scheduled appointment. Our office staff will be happy to inform you of our office and hospital financial assistance plans so that a suitable payment arrangement can be organized.
Should you have any questions or concerns please speak directly to our Office Manager at 205-759-7878.