Patient Information

Your Appointment:

Please bring the following to your scheduled appointment:

  • Your insurance card
  • A list of current prescription and/or over-the-counter medications you are taking (please include your dose and frequency)
  • Pertinent information about your medical and surgical history
  • Recent X-rays or other test results related to your condition
  • Completed patient form (PDF just below)


Patient Forms

Please print out and complete the following forms in advance and bring them to your appointment.

Patient Registration – click here
Patient Authorization Form – click here
Patient Medical History – click here
Review of Systems – click here

Insurance Information:

  • Medicare
  • And most other insurances

GulfStream Urology accepts most major insurance plans, however, please call our office to verify that we still accept your insurance provider. It is also in your best interest to check your insurance plan’s provider list to be sure it permits you to be seen in our office. Please be aware that your insurance provider may require a referral letter from your primary care provider. It is the responsibility of the patient or guardian to pay any co-payments, and other charges not covered by your insurance provider.

Today, many insurance providers require pre-authorization, second surgical opinions, limitations on hospital days, etc. Please review the rules and limitations of your coverage and inform our office of any restrictions.


Hospital Privileges:

We are affiliated with the following hospitals and treatment centers:

  • Health Park, Fort Myers, FL
  • Gulf Coast Hospital, Fort Myers, FL
  • Cape Coral Hospital, Cape Coral, FL
  • Lee Island Coast Surgery Center, Fort Myers, FL


Prostate Health – Hitachi & the Daller Difference

click here



Call Now Button