Reschedule Your Appointment
In submitting this form you acknowledge that you have read and accepted the terms of use.
CONTACT THE OFFICE BY PHONE DURING BUSINESS HOURS IF YOU ARE CANCELLING OR RESCHEDULING SURGERY.
Late notification fees may apply. Review the Office Policy on ‘No-Show/Late Cancellation Fees’.
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In selecting this option, you acknowledge that you understand the following:
We strongly recommend that you discuss the nature of your condition with your urologist or family physician if you are unsure if it is safe to terminate urological care.
You understand that your referring physician or your urologist believe that ongoing care is necessary to address your medical condition.
You understand that in certain circumstances (for example, cancer care, cancer screening or urinary tract obstruction) that failure to follow the advice of your physicians may lead to undesirable outcomes including but not limited to a worse prognosis or death.
We will make no further attempt to contact you.
We will not schedule additional appointments without a repeat referral.
We will send notification of your decision to terminate the relationship to the referring physician.
We remain available to address any emergent or urgent conditions at the request of another physician.
At any time, you may ask your family physician or other physician to:
Make a referral back to the same urologist or another urologist in our office. For referral to another urologist in our office we recommend that you review the information on second opinions in the ‘Office Policy’ section.
Refer you to another urologist in a different practice group.
