Patient Forms

For your convenience, Rogue Valley Urology makes our patient forms available online. We encourage you to print these forms and complete them before your visit. This enables us to make the most of your time in the office. Please present the forms to us when you check in for your visit, along with a list of your current medications, insurance card, and driver’s license or other photo ID.

Download Forms

Click here to download the new patient forms (pdf 225kb):

  • Patient Information Form
  • Consent Form
  • Financial Policy
  • Health History Form

Medical Records Requests

Please complete one of the following forms to request medical records from our office or request another entity send Rogue Valley Urology your records:

Release of Information– use this form if you want to request your records be sent to another entity or request another entity send your records to Rogue Valley Urology.

Patient Requesting Access to Their Medical Record – use this form if you are requesting a copy of your own medical record.

Patient Information Forms

Newborn Circumcision Instructions

Vasectomy Information and Consent

Instructions Concerning Vasectomy

Prep Information for Vasectomy Patients

Discharge Instructions for Vasectomy

Androgen Deficiency in the Aging Male Screening Form

AUA Symptom Score

Bladder Diary and Instructions pdf

Foley Catheter Care Instructions

Sexual Health Inventory for Men