Skip to content
The latest information on COVID-19 for our patients What You Need To Know
Advanced Urology Institute
  • Home
  • About Us
    • Our Team
    • Patient Testimonials
    • Locations
  • Conditions We Treat
    • Men’s Health
      • Bladder Problems
      • Erectile Dysfunction
      • Infections
      • Infertility
      • Kidney Problems
      • Kidney Stones
      • Peyronie’s Disease
      • Prostate Problems
      • Testicle Problems
      • Urinary Incontinence
      • Vasectomy
    • Women’s Health
      • Bladder Problems
      • Kidney Problems
      • Kidney Stones
      • Urinary Incontinence
      • Urinary Tract Infection
      • Urogynecology
  • Doctors & Clinics
    • Blountstown Office
    • Carrabelle Office
    • Clearwater Office
    • Daytona Beach Offices
      • Daytona Beach Office
      • SE Regional Prostate Cancer Treatment Center
    • DeLand Office
    • Dunedin Office
    • Fort Myers Office
    • Homosassa Office
    • Inverness Office
    • Largo Bardmoor Office
    • Leesburg Office
    • Naples Office
    • New Smyrna Beach Office
    • Ocala Offices
      • Timber Ridge Office
      • Windsor Oaks Office
    • Orange City Office
    • Oxford Offices
      • Advanced Prostate Cancer Institute
      • Oxford Leesburg Office
      • Oxford Ocala Office
    • Panama City Main Office
    • Palm Coast Office
    • Palm Harbor Offices
      • Palm Harbor East Lake Office
      • Palm Harbor US 19 Office
    • Perry Office
    • Port Orange Office
    • Radiation Oncology Center
    • Safety Harbor Office
    • St Augustine Offices
      • St Augustine Southpark Office
      • St Augustine Tuscan Office
    • St Petersburg Offices
      • St Petersburg Office 38th Street
      • St Petersburg Pasadena Office
    • Tampa Westchase Office
    • Tallahassee Office
    • Thomasville Office
    • Trinity Offices
      • Trinity Duck Slough Office
      • Trinity Oaks Office
    • Office Locator
  • News
  • Resources
    • Our Videos
    • Office Locator
    • Patient Satisfaction
    • Insurance Participation List
    • Contact Us
  • Careers
    • About Us
    • Providers
    • Team Members
    • AUI Benefits
  • Home
  • About Us
    • Our Team
    • Patient Testimonials
    • Locations
  • Conditions We Treat
    • Men’s Health
      • Bladder Problems
      • Erectile Dysfunction
      • Infections
      • Infertility
      • Kidney Problems
      • Kidney Stones
      • Peyronie’s Disease
      • Prostate Problems
      • Testicle Problems
      • Urinary Incontinence
      • Vasectomy
    • Women’s Health
      • Bladder Problems
      • Kidney Problems
      • Kidney Stones
      • Urinary Incontinence
      • Urinary Tract Infection
      • Urogynecology
  • Doctors & Clinics
    • Blountstown Office
    • Carrabelle Office
    • Clearwater Office
    • Daytona Beach Offices
      • Daytona Beach Office
      • SE Regional Prostate Cancer Treatment Center
    • DeLand Office
    • Dunedin Office
    • Fort Myers Office
    • Homosassa Office
    • Inverness Office
    • Largo Bardmoor Office
    • Leesburg Office
    • Naples Office
    • New Smyrna Beach Office
    • Ocala Offices
      • Timber Ridge Office
      • Windsor Oaks Office
    • Orange City Office
    • Oxford Offices
      • Advanced Prostate Cancer Institute
      • Oxford Leesburg Office
      • Oxford Ocala Office
    • Panama City Main Office
    • Palm Coast Office
    • Palm Harbor Offices
      • Palm Harbor East Lake Office
      • Palm Harbor US 19 Office
    • Perry Office
    • Port Orange Office
    • Radiation Oncology Center
    • Safety Harbor Office
    • St Augustine Offices
      • St Augustine Southpark Office
      • St Augustine Tuscan Office
    • St Petersburg Offices
      • St Petersburg Office 38th Street
      • St Petersburg Pasadena Office
    • Tampa Westchase Office
    • Tallahassee Office
    • Thomasville Office
    • Trinity Offices
      • Trinity Duck Slough Office
      • Trinity Oaks Office
    • Office Locator
  • News
  • Resources
    • Our Videos
    • Office Locator
    • Patient Satisfaction
    • Insurance Participation List
    • Contact Us
  • Careers
    • About Us
    • Providers
    • Team Members
    • AUI Benefits
  • Our Office Locations
Pay Online
Facebook-f
Twitter
Youtube
Pinterest
Instagram
Advanced Urology Institute Advanced Urology Institute
  • Home
  • About Us
    • Our Team
    • Patient Testimonials
    • Locations
  • Conditions We Treat
    Men’s Health
    • Bladder Problems
    • Erectile Dysfunction
    • Infections
    • Infertility
    • Kidney Problems
    • Kidney Stones
    • Peyronie’s Disease
    • Prostate Problems
    • Testicle Problems
    • Urinary Incontinence
    • Vasectomy
    Women’s Health
    • Bladder Problems
    • Kidney Problems
    • Kidney Stones
    • Urinary Incontinence
    • Urinary Tract Infection
    • Urogynecology
  • Doctors & Clinics
    • Blountstown Office
    • Carrabelle Office
    • Clearwater Office
    • Daytona Beach Offices
      • Daytona Beach
      • SE Regional Prostate Cancer Treatment Office
    • DeLand Office
    • Dunedin Office
    • Fort Myers Office
    • Homosassa Office
    • Inverness Office
    • Largo Bardmoor Office
    • Leesburg Office
    • Naples Office
    • New Smyrna Beach Office
    • Ocala Offices
      • Timber Ridge Office
      • Windsor Oaks Office
    • Orange City Office
    • Oxford Offices
      • Advanced Prostate Cancer Institute
      • Oxford Leesburg Office
      • Oxford Ocala Office
    • Panama City Main Office
    • Palm Coast Office
    • Palm Harbor Offices
      • Palm Harbor East Lake Office
      • Palm Harbor US 19 Office
    • Perry Office
    • Port Orange Office
    • Radiation Oncology Center
    • Safety Harbor Office
    • St Augustine Offices
      • St Augustine Southpark Office
      • St Augustine Tuscan Office
    • St Petersburg Offices
      • St Petersburg 38th Street Office
      • St Petersburg Pasadena Office
    • Tallahassee Office
    • Tampa Westchase Office
    • Thomasville Office
    • Trinity Offices
      • Trinity Duck Slough Office
      • Trinity Oaks Office
    • Office Locator
  • News
  • Resources
    • Our Videos
    • Office Locator
    • Patient Satisfaction
    • Insurance Participation List
    • Contact Us
  • Careers
    • About Us
    • Providers
    • Team Members
    • AUI Benefits
The latest information on COVID-19 for our patients What You Need To Know
Advanced Urology Institute
  • Home
  • About Us
    • Our Team
    • Patient Testimonials
    • Locations
  • Conditions We Treat
    Men’s Health
    • Bladder Problems
    • Erectile Dysfunction
    • Infections
    • Infertility
    • Kidney Problems
    • Kidney Stones
    • Peyronie’s Disease
    • Prostate Problems
    • Testicle Problems
    • Urinary Incontinence
    • Vasectomy
    Women’s Health
    • Bladder Problems
    • Kidney Problems
    • Kidney Stones
    • Urinary Incontinence
    • Urinary Tract Infection
    • Urogynecology
  • Doctors & Clinics
    • Blountstown Office
    • Carrabelle Office
    • Clearwater Office
    • Daytona Beach Offices
      • Daytona Beach
      • SE Regional Prostate Cancer Treatment Office
    • DeLand Office
    • Dunedin Office
    • Fort Myers Office
    • Homosassa Office
    • Inverness Office
    • Largo Bardmoor Office
    • Leesburg Office
    • Naples Office
    • New Smyrna Beach Office
    • Ocala Offices
      • Timber Ridge Office
      • Windsor Oaks Office
    • Orange City Office
    • Oxford Offices
      • Advanced Prostate Cancer Institute
      • Oxford Leesburg Office
      • Oxford Ocala Office
    • Panama City Main Office
    • Palm Coast Office
    • Palm Harbor Offices
      • Palm Harbor East Lake Office
      • Palm Harbor US 19 Office
    • Perry Office
    • Port Orange Office
    • Radiation Oncology Center
    • Safety Harbor Office
    • St Augustine Offices
      • St Augustine Southpark Office
      • St Augustine Tuscan Office
    • St Petersburg Offices
      • St Petersburg 38th Street Office
      • St Petersburg Pasadena Office
    • Tallahassee Office
    • Tampa Westchase Office
    • Thomasville Office
    • Trinity Offices
      • Trinity Duck Slough Office
      • Trinity Oaks Office
    • Office Locator
  • News
  • Resources
    • Our Videos
    • Office Locator
    • Patient Satisfaction
    • Insurance Participation List
    • Contact Us
  • Careers
    • About Us
    • Providers
    • Team Members
    • AUI Benefits
Advanced Urology Institute
  • Home
  • About Us
    • Our Team
    • Patient Testimonials
    • Locations
  • Conditions We Treat
    • Men’s Health
      • Bladder Problems
      • Erectile Dysfunction
      • Infections
      • Infertility
      • Kidney Problems
      • Kidney Stones
      • Peyronie’s Disease
      • Prostate Problems
      • Testicle Problems
      • Urinary Incontinence
      • Vasectomy
    • Women’s Health
      • Bladder Problems
      • Kidney Problems
      • Kidney Stones
      • Urinary Incontinence
      • Urinary Tract Infection
      • Urogynecology
  • Doctors & Clinics
    • Blountstown Office
    • Carrabelle Office
    • Clearwater Office
    • Daytona Beach Offices
      • Daytona Beach Office
      • SE Regional Prostate Cancer Treatment Center
    • DeLand Office
    • Dunedin Office
    • Fort Myers Office
    • Homosassa Office
    • Inverness Office
    • Largo Bardmoor Office
    • Leesburg Office
    • Naples Office
    • New Smyrna Beach Office
    • Ocala Offices
      • Timber Ridge Office
      • Windsor Oaks Office
    • Orange City Office
    • Oxford Offices
      • Advanced Prostate Cancer Institute
      • Oxford Leesburg Office
      • Oxford Ocala Office
    • Panama City Main Office
    • Palm Coast Office
    • Palm Harbor Offices
      • Palm Harbor East Lake Office
      • Palm Harbor US 19 Office
    • Perry Office
    • Port Orange Office
    • Radiation Oncology Center
    • Safety Harbor Office
    • St Augustine Offices
      • St Augustine Southpark Office
      • St Augustine Tuscan Office
    • St Petersburg Offices
      • St Petersburg Office 38th Street
      • St Petersburg Pasadena Office
    • Tampa Westchase Office
    • Tallahassee Office
    • Thomasville Office
    • Trinity Offices
      • Trinity Duck Slough Office
      • Trinity Oaks Office
    • Office Locator
  • News
  • Resources
    • Our Videos
    • Office Locator
    • Patient Satisfaction
    • Insurance Participation List
    • Contact Us
  • Careers
    • About Us
    • Providers
    • Team Members
    • AUI Benefits
  • Home
  • About Us
    • Our Team
    • Patient Testimonials
    • Locations
  • Conditions We Treat
    • Men’s Health
      • Bladder Problems
      • Erectile Dysfunction
      • Infections
      • Infertility
      • Kidney Problems
      • Kidney Stones
      • Peyronie’s Disease
      • Prostate Problems
      • Testicle Problems
      • Urinary Incontinence
      • Vasectomy
    • Women’s Health
      • Bladder Problems
      • Kidney Problems
      • Kidney Stones
      • Urinary Incontinence
      • Urinary Tract Infection
      • Urogynecology
  • Doctors & Clinics
    • Blountstown Office
    • Carrabelle Office
    • Clearwater Office
    • Daytona Beach Offices
      • Daytona Beach Office
      • SE Regional Prostate Cancer Treatment Center
    • DeLand Office
    • Dunedin Office
    • Fort Myers Office
    • Homosassa Office
    • Inverness Office
    • Largo Bardmoor Office
    • Leesburg Office
    • Naples Office
    • New Smyrna Beach Office
    • Ocala Offices
      • Timber Ridge Office
      • Windsor Oaks Office
    • Orange City Office
    • Oxford Offices
      • Advanced Prostate Cancer Institute
      • Oxford Leesburg Office
      • Oxford Ocala Office
    • Panama City Main Office
    • Palm Coast Office
    • Palm Harbor Offices
      • Palm Harbor East Lake Office
      • Palm Harbor US 19 Office
    • Perry Office
    • Port Orange Office
    • Radiation Oncology Center
    • Safety Harbor Office
    • St Augustine Offices
      • St Augustine Southpark Office
      • St Augustine Tuscan Office
    • St Petersburg Offices
      • St Petersburg Office 38th Street
      • St Petersburg Pasadena Office
    • Tampa Westchase Office
    • Tallahassee Office
    • Thomasville Office
    • Trinity Offices
      • Trinity Duck Slough Office
      • Trinity Oaks Office
    • Office Locator
  • News
  • Resources
    • Our Videos
    • Office Locator
    • Patient Satisfaction
    • Insurance Participation List
    • Contact Us
  • Careers
    • About Us
    • Providers
    • Team Members
    • AUI Benefits

General Forms

  1. Home
  2. General Forms

    Your health is our priority at Advanced Urology Institute. To help us serve you better, please complete the Patient Information Forms and bring them to your initial appointment.

    pdfPatient Information Sheet

    OR

    try the new Online Patient Information Form

    pdfNotice of Privacy Practices – AUS 2013

    pdfAcknowledgement of Receipt of Notice of Privacy Practices – AUS 2013

    Our Offices

    Our Provider Locator

    Patient Care

    • Bladder Problems
    • Erectile Dysfunction
    • Kidney Stones
    • Peyronie’s Disease
    • Prostate Problems
    • Urinary Incontinence
    • Pelvic Organ Prolapse
    • Urinary Tract Infection
    • Vasectomy
    Advanced Urology Institute Advanced Urology Institute

    Information

    • About Us
    • Men's Health
    • Women's Health
    • Our Doctors and Staff
    • Blog
    • Contact Us

    Contact Us

    • Our Office Locations

    Follow Us On

    Facebook-f
    Twitter
    Youtube
    Pinterest
    Instagram
    Privacy Notice

    Find Us

    Office Locator

    Copyright Advanced Urology Institute | All Rights Reserved © 2019

    Language Assistance Available: Español, Kreyòl Ayisyen (French Creole), Tiếng Việt (Vietnamese), Português (Portuguese), 繁體中文 (Chinese), Français (French), Kreyòl Ayisyen (French Creole), Tagalog (Tagalog – Filipino, Русский (Russian), لعربية, Italiano (Italian), Deutsch (German), 한국어 (Korean), Polski (Polish), ภาษาไทย (Thai), ગુજરાતી (Gujarati), አማርኛ (Amharic), हिंदी (Hindi), فارسی