Dallas ~ Fort Worth ~ Plano ~ Allen
Garland ~ Grapevine ~ Flower Mound
Rockwall ~ Sunnyvale
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Urology Clinics of North Texas at Baylor University Medical Center

Patient Forms

New Patient Adult History Forms

New Patient Medical History & Information Form, Including AUA Symptom Index and Karnofsy Score

Formulario De Historial De Salud Para Adultos

Pediatric Forms

New Patient Pediatric Forms

Authorization to Use or Disclose Protected Health Information Form

Click here to download the following form: Request and Authorization for the Release of Medical Records to Urology Clinics of North Texas

Click here to download the following form: Authorization for the Release of Medical Records from North Texas Pediatric Urology Associates

David H. Ewalt, M.D., Vesicoureteral Reflux Handout

Click here to download a Patient Handout on Vesicoureteral Reflux, (VUR). A condition that affects approximately 1% of all children and is often associated with Urinary tract infections (UTls). New window will open, 12MB PDF.

Patient Consent Forms

Consent to Photograph and Quote

Media Authorization for the Use and Disclosure of Protected Health Information

 

 

About Urology Clinics of North Texas | Urology conditions treated at UCNT: prostate cancer, kidney cancer, ureteral cancer, bladder cancer, testicular cancer, kidney stones, enlarged prostate (benign prostatic hyperplasia), male and female incontinence, erectile dysfunction, female infertility, male infertility, voiding dysfunction, male and female urinary urgency and frequency | Technology and Robotic Surgery at Urology Clinics of North Texas, robotic prostatectomy, vasectomy | In the News | Patient Information | Contact Urology Clinics of North Texas | Location information for our urology offices in Dallas, Plano, Allen, Garland, Grapevine, Rockwall, Sunnyvale

 

You're In Control - an incontinence program

Sexual Health - a wellness program

Prostate Health - a wellness program

Kidney Health - a wellness program

     
     
         
  
     
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