New Patient Paperwork

ONLINE Secure Patient Forms

These 6 forms can be filled out online and will be sent to a secure email in our office.

Patient Information
Insured's Information
Medical History
Acknowledgement of Financial Policy
Medical Information Release Form
HIPAA Release Form
History

OR

Print PDF Forms to bring with you to your appointment

Patient Information
Insured's Information
Medical History
Privacy Practices
Acknowledgement of Financial Policy
HIPAA Release Form
History

RELEASE OF MEDICAL RECORDS

Please fill out this form and take it to the physician you are requesting records from. If you are a new patient with us please fill out either the 6 online secure patient forms above OR print off and fill out the PDF forms to bring into the office when you bring us your records.

Release of Information


Adobe Acrobat Reader Download In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

 CONTACT US

GILLESPIE COUNTY UROLOGY
1892 W US HWY 290
Fredericksburg, TX 78624
Phone: 830-304-1666
Fax: 830-304-1665

 

Our Location

Office Hours

Our office is closed from 12-1 everyday for lunch.

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

8:00 am-5:00 pm

**Every Other Friday

Saturday:

Closed

Sunday:

Closed