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Patient Forms


Please fill out the forms below and bring them to your appointment. Bring in any current X-rays, CT scans, MRI or films along with the reports, if available. Any previous operative reports would also be helpful. Please also bring your insurance card and referral forms if required by your insurance company.


New Patient Information

Medical History

Review of Symptoms

Female Urologic Symptoms (women only)

Male Urologic Symptoms (male only)

Release of Information Authorization



Pacific Northwest Urology Specialists
3232 Squalicum Pkwy
Bellingham, WA 98225
Phone: 360-218-7137
Fax: 360-734-7687
Office Hours

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