Patient Forms

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If you have an appointment scheduled with one of our Urology specialists, please print and fill out the following forms and bring them with you on the day of your appointment to help expedite the check-in process. If you have any questions on how to fill out the forms, or general questions about your appointment please call us at 617-355-7796.

- Patient/guardian questionnaire: gathers contact information and medical back ground

- Insurance form: authorizes our department to release information and assign insurance benefits through your insurance company

- Notice of Privacy practices form: acknowledges that you have read and understood the Boston Children’s Hospital Notice of Privacy Practices

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO