Patient Forms

Patient Information Form

Open/download Patient Check In Form

Medical Background Form

Open/download Patient History Form

Medical Records Request Form

Open/download Medical Records Request Form

Notice of Privacy

Open/download Notice of Privacy

Local Procedure Forms

Open/download Botox Consent Form

Open/download Cystoscopy Consent Form

Open/download Trus & Biopsy Consent Form

Open/download Urodynamics Consent Form

Open/download SurgiCare Payment Policy

What we offer

Services

Premature Ejaculation

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Prostate

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Prostate Cancer

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Hormone Replacement Therapy

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Incontinence

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Kidney Stones

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Men's Health

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Vasectomy

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Vasectomy Reversal

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PSA

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CT Scan

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E.D.

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Location

Summit Urology
2907 McIntire Drive
Bloomington, IN 47403
Phone: 812-289-7264
Fax: 812-336-3425

Office Hours

Monday 8:00 am to 5:00 pm Tuesday 8:00 am to 5:00 pm Wednesday 8:00 am to 5:00 pm Thursday 8:00 am to 4:00 pm Friday 8:00 am to 12:00 pm Saturday Closed Sunday Closed

Get in touch

812-289-7264