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Jennifer Our Transcriptionist

Select the appropriate form that may apply to your condition or those required for your first appointment. Please answer the questions and fill out the forms to the best of your ability and as accurate as possible. This will allow us to provide a more thorough assessment of each
patient's situation and symptoms.

All forms shoud be printed out and faxed to us at 989-799-4994. Please be sure to include a cover sheet with your contact information. Please note that any information faxed to us is held in complete confidence. However, if you prefer, you may bring your forms with you to your first visit.

Initial Consultation

New Patient Database Form
New Patient History Form

Questionnaires

Overactive Bladder Form
Pelvic Pain Questionnaire Form
Low (T) Testosterone Form




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1740 MIDLAND ROAD • SAGINAW, MI 48638 • PHONE 989-799-4840 • FAX 989-799-4994