In order to ensure a good and productive in-person or telemedicine/telephone visit, Dr Urick wants to ensure we have the most up to date information on you.
THIS FORM IS HIPAA SECURE! We will receive it securely once you submit it
• Not all specialists send records to us. If you have seen someone recently and we did not receive records, Dr Urick will attempt to get them before your visit.
• If you had labs, imaging tests, etc we would like to know to update our records.
• If you will need refills on medications, please comment here. (NOT ALL PHARMACIES contact Dr Urick for refills. Some have told patients refills were denied. Anyone who was told a medication was denied, please let Dr Urick know)