New Patients

New Patient Forms
Please email these two forms, or print out the PDF versions, fill them out and bring them with you on your first visit:

Patient Information:
PDF Form

Medical Information:
PDF Form

Referring Physician Patient Form:
Please email us your patient’s information or print out the pdf version, fill out and fax it to 231-775-0744. Thank you.
PDF Form

Questionnaires for Specific Difficulties
Please print the appropriate form, fill it out, and bring it with you on your next visit:

If you are having problems with erectile difficulties, click here.

If you are having problems with your prostate, including incomplete emptying, frequency, intermittency, urgency, weak stream, straining, or frequent nighttime urination, click here (I-PSS).

If you are having urinary difficulties including frequency and urgency, click here (Patient Assessment).

Documents are in PDF format. If you have difficulty opening a document, you may download a free PDF reader by clicking here.