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Patient Forms and Instructions
Your provider may ask that you complete or review the following forms and information. If you need help or more information, email the patient navigator at firstname.lastname@example.org.
For new patients:
- New Patient Letter
Welcome information to prepare you for your first appointment.
- Patient History Form
Questionnaire regarding your medical history and symptoms.
- Urodynamics/Cystoscopy Information Pamphlet
What to expect during urodynamic testing.
- Post-Operative Instruction Sheet
Instructions for care after your surgery.
General information and instructions:
- Bladder Diary
A form to help you track your fluid intake and output for a 24-hour period.
- Bladder Drills/Timed Voids
Instructions for bladder drills/timed voids that may help you urinate less frequently.
- Bladder Irritants
Listing of foods and beverages that have been linked to symptoms of urinary frequency, urgency, urge incontinence or bladder pain.
- Bowel Regularity
Information to prevent constipation and promote bowel regularity.
- Fiber Information Sheet
Guidelines for following a high-fiber diet.
- General Vulvar Care
"Do"s and "don’t"s to keep the vulva dry and free from irritants.
- Instructions for Patients with Catheter Bags
Tips for the use and care of catheter bags.
- Self-Catheterization Instruction Sheet
Instructions for self-catheterization to help you empty your bladder.
- Self-Catheterization Record
A chart to track self-catheterization.
- Vaginal Lubrication Products
Product recommendations and descriptions for vaginal lubrication.
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