Patients

To help make your visit to Mercy Specialty Clinics, Urology as stress-free as possible, we ask that you please complete the following forms prior to your appointment and bring them with you to your appointment.

If you have any questions at all, please don’t hesitate to contact us. Our friendly staff is here to assist you.

Patient Registration Form

Patient Medical History Form

Patient Release Form

Helpful Information we will ask you for.

  • PCP – Primary Care Physician: A PCP is the doctor you go to for an annual physical or when you have a cold.  Often times, this is the physician who referred you to our clinic.
  • Primary Clinic: To help us better serve you, it is helpful to know what the office location (city) where you see your PCP.
  • Primary Pharmacy (Name/City): If we need to send a prescription on your behalf, we like to make sure we send it to the correct pharmacy.