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New Patient Information

The first step in your evaluation requires that you complete a simple questionnaire and bladder diary (a record of how much you drink and how often you urinate). This is done prior to your first visit. I will then carefully review your history and these records so that I can fully understand the nuances of your problems and of your prior history related to your problems. Any and all records from previous care rendered will be reviewed; and therefore, it is always important to bring these records with you to your first visit. A comprehensive physical examination will then be done to determine the extent of any physical concerns, as well as an evaluation of pelvic muscular strength and function.

To save time on the day of your appointment, please fill out these forms and bring them with you:

• Patient Questionnaire
• Pelvic Pain Assessment Form
• Pelvic Pain and Urgency/Frequency Form
• Medical Records Release Form

Your second office visit is designed to do some tests to evaluate your bladder function called Urodynamics (URO I). These tests involve filling your bladder with water to assess this bladder function and attempting to reproduce your particular symptom (incontinence, bladder pain, urgency, incomplete bladder emptying, etc). We will also want to determine how well you empty your bladder. Therefore, it is very important that when you arrive at the office your bladder is full. We suggest that you drink 12 oz. of fluid 1½ hours prior to arrival at the office and attempt to hold your urine until we ask you to void on our special commode. We have found that this is an adequate amount and you do not have to drink more than this. We also need you to be off your anticholinergic medications, such as Detrol, Ditropan, Oxytrol, Sanctura 3 days prior to the test and VESIcare and Enablex for 5 days prior to the test.

The last office visit (URO II) will involve a small scope designed for a woman's bladder. The scope will be used to visualize the inside of your bladder and urethra to further evaluate bladder anatomy and function. Therefore, it is very important that when you arrive at the office your bladder is full. We suggest that you drink at least 12 oz. of fluid 1½ hours prior to arrival at the office and attempt to hold your urine until we ask you to void on our special commode. I will then discuss with you (and your family when appropriate) the probable cause of your symptoms, and review with you the management plan that fits your needs.

If for any reason you are unable to keep these initial evaluation visits, we request that you notify our office at least 24 hours in advance. Deductibles, coinsurances, and co-pays are required at the time of service.

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If you have any questions or comments, or if you want to learn more about the services we provide, please call us or complete the form below.

Note: Do not use this form in case of an emergency!

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