Patient Information
Patient Forms
To help prepare you for your appointment, we ask that you print and complete our new patient information packet. Please click on the appropriate forms below.
If you are requesting Worcester Urological Associates release your medical information, please print and complete the Patient Medical Record Release Form.
If you are requesting Worcester Urological Associates release your medical information, please print and complete the Patient Medical Record Release Form.
- Downloadable Documents
Prescription Refills
**Please contact our office during normal business hours for refill requests. If there is no one to take your call, at that time, please leave a detailed message on the Clinical Staff line. Please allow 48 hours for the script to be sent to your pharmacy. Only emergency medications are called in after business hours or on weekends. You may also send a message for a refill to our patient portal
Please leave the following information when requesting refills:
Name of the patientPatient date of birthTelephone number where you can be reachedPharmacy name and telephone number
**If you have not been seen in this office, in the past 12 months you must schedule an appointment in order to receive a refill.
Please leave the following information when requesting refills:
Name of the patientPatient date of birthTelephone number where you can be reachedPharmacy name and telephone number
**If you have not been seen in this office, in the past 12 months you must schedule an appointment in order to receive a refill.
Test Results
All test results are reviewed by your doctor/ nurse practioner. Results will be given to you at your follow up appointment. Results are not given over the phone. If your results are abnormal you will be contacted by one of the providers with the results and a follow up plan for treatment. Laboratory results can take up to 5 days for most tests, but there are some, that may take as long as ten days.
Medical Records
Medical Records RequestWe must have your expressed written permission to release your medical records to other physicians, attorneys, and any family members. Please give us 7-10 days notice when requesting such records. There is a $50.00 fee for records that are sent to an attorney or insurance company.
Worcester Urological HIPAA Privacy PracticesNotice of the above is posted in the office and copies are available upon request. This notice explains how your medical information may be disclosed and how you may obtain access to this information.
Appointments
To Schedule Appointments:Worcester Urological Associates accepts referrals from physicians, as well as self referrals. To schedule an appointment, please call 508-756-6293Patient appointments are available:Mon - Thurs, 8:30am - 12pm & 2pm - 4:30pmFriday, 8:30am - 12pm
Please note that there are times when the doctors are called out of the office for emergency surgery, detained in surgery and at times we may need to delay or reschedule your appointments.
New Patient AppointmentsPlease print and complete the "New Patient" and "Medication List" forms, and bring them to your visit.
Note: Without a proper INSURANCE REFERRAL sent to us in time for your appointment, your appointment may need to be rescheduled.
Please be sure to have your INSURANCE CARD and a government issued PHOTO ID. You are responsible for your copayment if you have one and payment is expected at the time of your visit, unless prior arrangements have been made with our office. We do except cash, checks and most credit cards. If you are not able to download the new patient forms, please contact the office and we will be happy to print them and send them to you in the mail.
Additional Information Relating To Your VisitPlease bring or have forwarded to our office:
- Any recent lab work that has been performed(Urine Culture and Sensitivity, PSA History).
- Diagnostic tests done by your PCP or referring physician or hospital (CAT scan, Ultrasounds, MRI or X-rays.)
- Any medical records that relate to your current urological issue.
- A complete list of your prescription medications and over the counter medications including vitamin supplements.
- Insurance Cards and/or Referral forms
If You Arrive LateWe will make every effort to fit you in, however, sometimes it may not be possible and your appointment will need to be rescheduled.
Urgent/Same DayWe have appointments available for urgent visits with our Nurse Practioner Mary DeCesare-Flaherty, N.P.-C. Mary is available to see patients 13 years and older. If you receive a voice mail, please leave your name, telephone, and the reason for the appointment and someone will return your call as soon as possible.
If you have an emergency after business hours or on a weekend please contact our office at 508-756-6293 and our answering service will page the doctor on call. When expecting a call from one the physicians, please disable your caller ID and or private/blocked call.
Surgeries are performed at either UMassMemorial-Memorial Campus and in some cases St. Vincent Hospital, both in Worcester, MA. Diagnostic work-ups are performed routinely at UmassMemorial, or a facility of your choice.
If you have an emergency after business hours or on a weekend please contact our office at 508-756-6293 and our answering service will page the doctor on call. When expecting a call from one the physicians, please disable your caller ID and or private/blocked call.
Surgeries are performed at either UMassMemorial-Memorial Campus and in some cases St. Vincent Hospital, both in Worcester, MA. Diagnostic work-ups are performed routinely at UmassMemorial, or a facility of your choice.
Financial PolicyIn order to reduce confusion and misunderstanding between our patients and the practice, we have adopted the following financial policy. If you have any questions, please discuss them with our billing staff or our office manager. We are dedicated to providing the best possible care and service to you and regard your complete understanding of our financial policies as an essential part of your care and treatment.
Unless other arrangements have been made by either yourself or your health coverage carrier, full payment for office services are due at the time of service
We have prior arrangements with many health plans to accept an assignment of benefits. You will be required to make the co-payment at the time of your appointment. Should your insurance require a referral and one is not obtained, you will be asked to sign a waiver, making you responsible for payment of services if no referral is received.
Unless other arrangements have been made by either yourself or your health coverage carrier, full payment for office services are due at the time of service
We have prior arrangements with many health plans to accept an assignment of benefits. You will be required to make the co-payment at the time of your appointment. Should your insurance require a referral and one is not obtained, you will be asked to sign a waiver, making you responsible for payment of services if no referral is received.
Cancellation / No-Show Policy
Worcester Urological makes an effort to remind you in advance of your appointment, however, if you should need to cancel your appointment, WUA requires 24 hours advance notice. If you don’t give 24 hours advance notice for IN-OFFICE PROCEDURES (Vasectomies) there is a $50.OO CANCELLATION/NO SHOW FEE. We request this fee be paid before we will reschedule your procedure.