INITIAL VISIT

On your initial visit please be prepared to share your medical history with Dr. Kaufman. This will include any medical conditions you have or may have had in the past, surgical history, any medications (prescription or over-the-counter) you are currently taking (include name, dosage and frequency), and any allergies you have to medications or foods.

PAYMENT AND INSURANCE

Central Park Urology accepts most insurance and HMOs, including Medicare, as well as Visa, MasterCard and American Express.

PATIENT FORMS

For your convenience, we are providing you with the following forms: please fill them out at home and bring them with you to your first visit.

• Patient Registration Form
• Patient History Form

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NOTICE OF HEALTH INFORMATION PRACTICES

The Notice of Health Information Practices describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully. You will be asked to sign a consent form.

Central Park Urology
David M. Kaufman, M.D.
DIPLOMATE OF THE AMERICAN BOARD OF UROLOGY

330 West 58th St., Suite 401
New York, NY 10019
Tel: 212.969.9540
Fax: 212.969.9547
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E-mail Dr. Kaufman
www.centralparkurology.com