To download it, Patient Information Forms
Current patients may wish to download and read the following informational forms as applicable:
- BCG for Bladder Cancer Information
- Benign Prostatic Hypertrophy (BPH)
- Cystoscopy
- Erectile Dysfunction (ED)
- Kidney Cysts
- Low Testosterone
- PSA (Prostate Specific Antigen) Testing
- Pro-Nox Consent Form
- Pro-Nox Information
- Prostate Biopsy
- Prostate Biopsy (MRI Fusion)
- Rezūm Discharge Instructions
- Surgery Scheduling
- Transurethral Resection of the Prostate (TURP)
- Ureteral Stents
- Ureteroscopy & Laser Lithotripsy of Stones
- Urinary Catheters
- Urolift Discharge Instructions
- Urinary Retention - Acute
- Urinary Retention - Overflow
- Vasectomy
- New Patient Forms (English) - Female
- New Patient Forms (English) - Male
- New Patient Forms (Spanish) - Female
- New Patient Forms (Spanish) - Male
- Notice of Privacy Practices (English)
- Notice of Privacy Practices (Spanish)
Please be sure to discuss specific concerns or questions regarding these forms with Dr. Disick or our staff.
Your Appointment
Please bring the following information to your appointment:
- Your current insurance card
- A list of your current medications (both prescription and over-the-counter), including your dose and frequency
- Information pertaining to your medical and surgical history
- Copies of X-rays, CAT scans, ultrasounds, or other imaging studies
- Recent lab work related to your condition, such as blood tests, urine cultures, or PSA screening results
- Completed patient forms
- Photo ID
- Your co-pay, as determined by your insurance carrier. We accept cash, Mastercard, Visa, and American Express. No Discover cards or personal checks. Please be aware that an additional $5 fee will be charged if you do not have your co-pay at the time of the visit.
- There will be a $30 fee charged for a missed appointment not cancelled by the patient one business day prior to the visit.
Office Hours
Monday 8am - 4pm
Tuesday 8am - 4pm
Wednesday 8am - 4pm
Thursday 8am - 4pm
Friday 8am - 1pm
Please note:
Dr. Disick’s current schedule:
Monday - Friday: Office (8am - 12pm).
Monday & Wednesday: Office (1pm - 4pm).
Tuesday, Thursday, Friday Afternoon: Surgery
If an emergency occurs after business hours or on the weekend, please call the office and follow the prompts to leave a voice message that will be sent to the Physician On Call. Speak clearly and leave your name and phone number on the message. Please also disable any caller ID blocking features that you may have on your phone.
Insurance Information
We accept most major insurance plans, including:
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Please call our office to confirm that we still accept your insurance provider as the above list can change. It is also recommended that you check your insurance plan's provider list to be sure it allows you to be seen in our office. Please be aware that your insurance plan may require a referral from your primary care provider.
Privacy Practice and HIPAA
Notice of our Privacy Practice can be downloaded here and is also available in the office.
Requests for Medical Records
As a state-of-the-art practice, our office is completely paperless. All medical records are electronic and completely secured with multiple levels of password protection to protect our patient's privacy. You may notice our physicians taking notes on small portable computers during your visit.
All medical records are the property of GRANT DISICK, M.D., P.A. With the exception of continuity of your medical care, we will not release any information to other physicians, insurance companies, attorneys or family members without your express written permission. A signed "Authorization to Release Medical Information" will be kept on file. We will provide information to your referring physician and other physicians. Other than emergencies, we will require a two week notice for fulfilling any medical record requests.