Carlos G. Arcangeli, MD & Mark A. Rosen, MD

Adult and Pediatric Urology

New Patient Information

Welcome to our Urology practice, we are happy to provide you with the highest quality urologic care and the ease of working with our helpful office staff. Our doctors plan to spend as much time with you as necessary to address your needs, the first visit can last as long as 30 minutes. There are several forms that you will need to fill out for your first visit so that we have correct contact and billing information, and information about your general health. We have tried to keep these forms to a minimum, but we understand that they may be a burden for some patients to fill out. You are welcome to come to your appointment 15 minutes early to fill out these forms, or you can download them and fill them out at home before your appointment.

We are able to access some information about your medical condition and your reasons for seeing us online, and we may get some information from the referring doctor. It is very helpful to us if you can provide as much information as possible at your visit, including an accurate list of your current medications. Please let us know before your visit if you have had recent x-rays or blood tests so our doctors can review the results before your visit. Below is a list of forms that you can fill out and information regarding our privacy practices and our use of arbitration agreements. We look forward to caring for you.

Forms for New Patients

The links below will display a packet of forms and documents that can be printed and filled out before your appointment

New Patient Forms-Dr. Arcangeli

New Patient Forms-Dr. Rosen

Individual Forms and Documents

These documents are included in the forms for new patients above, but you can view each individually

HIPAA Notice of Privacy Practices

Letter to our Patients Regarding Arbitration-English This letter describes our request that you sign an arbitration agreement to resolve any disputes over medical care

Un Mensaje Para Nuestros Pacientes Sobre Arbitraje

Acknowledgement of Receipt of Notice of Privacy Practices We are required to provide you with a document called the “HIPAA Notice of Privacy Practices” that details how we will protect your medical information, and the information that we are required to provide to your insurer and other entities. Please feel free to discuss our privacy practices with us, we know that protecting your privacy is of the utmost importance.

AUA Symptom Score The AUA symptom score is used by urologists around the world to determine the severity of men’s urinary symptoms

Patient Demographics This form includes your name, address, phone numbers, email adresss and other important information

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