Top Nav

Dr. Siegel's books
Dr. Siegel's Blog
Urology Health Store
Patient Videos
Patient Education
Patient Info
New Patient Forms
Post-op Instructions
Contact Info

Stress Urinary Incontinence
[PDF help]

Appointment Request
[PDF help]

Patient Survey
[PDF help]

Back to top
Bottom Nav
Bergen Urological Associates, PA

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:

  1. Male Patient Information Forms
  2. Female Patient Information Forms

[PDF Help]

Our mailing address is:

255 W. Spring Valley Ave.
Suite 101
Maywood, NJ 07607
Attention: Medical Records

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:

  1. If you have any x-rays, medical records, lab results, or other pertinent medical history, please bring that with you.
  2. When you come for your appointment, please arrive twenty minutes early so that we may process your information.
  3. You may need to provide a urine sample as part of your exam, so do not empty your bladder before seeing the nurse.

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.


The Physicians and Staff of Bergen Urological Associates

Our Website Disclaimer

Bergen Urological Associates


255 W. Spring Valley Ave.
Suite 101
Maywood, NJ 07607
Tel: 201.342.6600
Fax: 201.342.4222


222 Cedar Lane
Suite 206
Teaneck, NJ 07666
Tel: 201.342.6600
Fax: 201.342.4222