Dawn Maria Scarzella, M.D.
  • Welcome
  • About the Doctor
    • MEET OUR MEDICAL TEAM
    • MEET THE OFFICE TEAM
    • ABOUT OUR OFFICE
  • Urology Topics
    • FEMALE UROLOGY >
      • Bladder Overview
      • Blood in the Urine: Hematuria
      • Overactive Bladder
      • Urinary Incontinence
      • Urinary Tract Infection
      • Chronic Cystitis and Trigonitis
      • Bladder Pain: Interstitial Cystitis
      • Neurogenic Bladder
      • Pelvic Organ Prolapse
      • Bladder Cancer
      • Kidney Overview
      • Kidney Stones
      • Kidney Cancer
    • MEN'S HEALTH >
      • Prostate Overview
      • BPH: Enlarged Prostate
      • Prostate Cancer
      • Prostatitis
      • Low Testosterone
      • ED: Sexual Dysfunction
      • Kidney Overview
      • Kidney Stones
      • Male Infertility
      • Hematuria
      • Hydrocele
      • Bladder Overview
      • Bladder Cancer
      • Overactive Bladder
      • Kidney Cancer
      • Overview of the Testes
      • Vasectomy
      • Overview of the Penis
  • Office Procedures
    • Cystoscopy
    • Urodynamics
    • Kidney Ultrasound
    • Bladder Biopsy and Fulguration
    • Bladder Neuromodulation >
      • Tibial Nerve Stimulation: Urgent PC
      • Interstim Therapy
    • Urgent PC: Tibial Nerve Stimulation
    • Bladder Botox
    • Prostate Biopsy: Ultrasound guided
    • BCG Immumotherapy
    • Mona Lisa Touch Laser
  • Forms
  • Contact US
    • After Hours
  • LIVING A SMART AND HEALTHY LIFE
    • Let's Prevent Disease!
  • Patient Education
    • Let's Prevent Disease!
    • Non-Toxic Living >
      • EWG: Envirnmental Working Group
    • Kidney Stone Diet
    • Kegel Exercises
    • Bladder Diet: Low Acid Diet
    • Urethral Sling
    • Shock Wave Lithotripsy & Ureteroscopy
    • Biofeedback
    • Urgent PC: Tibial Nerve Stimulation Video
    • Urine Culture and Lab Test Results
    • Urodynamics and Imaging Study Results
    • Pre-Op & Post-Op Instructions
    • Foley Catheter Care
  • Mona Lisa Touch Laser

MEDICAL HISTORY FORMS

PRINT MEDICAL HISTORY FORMS
NEW PATIENT REGISTRATION FORMS


What do I need to bring with me to my first appointment?

The "NEW PATIENT MEDICAL HISTORY FORMS" which you can print by clicking above and fill out prior to your appointment. 
                               

Please be sure to bring a Photo ID, a driver's license is best, as well as your insurance card. 

If your insurance requires a written referral from your family physician, please bring that as well.

Your current medication list and a list of any antibiotics you have taken within the last year.

Additionally, If you have recently had any lab work or x-rays done relevant to your appointment with us, please bring those reports and films on a CD disc as well. 


X-rays can now be obtained from each radiology center on a CD which we then review on our computer. You need to ask for the CD copy to be given to you. It will not be automatically sent to the office.

Imaging from Coral Springs Medical Center only is linked to our software so CD's are not needed from there.

Spanish is spoken fluently in our office.


We look forward to seeing you!

Request an Appointment
      954-752-3166
Photo used under Creative Commons from Karol Kalinowski