Image 9New Patient Forms

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

In order to view or print these forms you will need Adobe Acrobat Reader installed.

Your Appointment at Sequoia Urology Center

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
  • Registration and history forms
  • Insurance referral if required by your insurance

Insurance Information

Insurance Accepted:

  • Aetna
  • Blue Cross-PPO (no Covered CA, Pathways PPO or Select Plans)
  • Blue Shield- all plans
  • Cigna
  • Coventry
  • Health Net
  • Medicare
  • Hill Physicians NetworkUnited Health Care

Dr. Threatt 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 at the time of service.

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.