| |
 |
|
New Patient Forms Welcome! We would like to take this opportunity to welcome you to Bergen Urological Associates and to thank you for choosing our organization for your urologic needs. We are constantly striving to make our offices more efficient. Please mail or fax these completed forms to our office prior to your appointment. We will be able to assist you more efficiently when you arrive at our office by sending us this information before your appointment. Please take a few moments to print and complete the following forms:
Our mailing address is:
20 Prospect Avenue or Fax: 201.342.4222 As required by law, we are providing you a copy of our Notice of Privacy Practices. We do not require you to print this information; however, what is required is that we have on file your written acknowledgement of receiving this information. Please review this information prior to signing the acknowledgement form. Please remember the following items for your first appointment:
When you arrive, please pick up a copy of our practice brochure at the front desk or in the lobby. This will give you more specific and detailed information about the "ins and outs" of our practice. Thank you again for choosing Bergen Urological Associates. We look forward to seeing you. Sincerely, The Physicians and Staff of Bergen Urological Associates
|
||
Hackensack University Medical Plaza
|
|||
