Downloadable Forms

Your First Visit

Welcome to our practice. The links below will open our new patient information packets. This completed packet will provide your physician with information vital for your upcoming visit. Please complete the forms and bring the completed packet with you to your appointment. Our male patients may fill out the Sexual Health Inventory for Men, if it applies.

Form DescriptionDownload
New Patient Information MalePDF icon  DOWNLOAD FORM
New Patient Information FemalePDF icon  DOWNLOAD FORM
Existing Patient Information MalePDF icon  DOWNLOAD FORM
Existing Patient Information FemalePDF icon  DOWNLOAD FORM
Release of Information FormPDF icon  DOWNLOAD FORM
Care Provisions PoliciesPDF icon  DOWNLOAD FORM
HIPAA Patient Privacy FormPDF icon  DOWNLOAD FORM
HIPAA Privacy Acknowledgement & Designated Party FormPDF icon  DOWNLOAD FORM
Urine Specimen Drop-Off FormPDF icon  DOWNLOAD FORM

Procedures, Conditions & Instructions

Certain Procedures require additional information for our patients.  Please refer to the following forms that detail your specific procedure and contact us with any questions.

Form DescriptionDownload
BalanitisPDF icon  DOWNLOAD FORM
Bladder TumorPDF icon  DOWNLOAD FORM
Blood Thinning MedicationsPDF icon  DOWNLOAD FORM
Catheter Care InstructionPDF icon  DOWNLOAD FORM
Catheter Removal InstructionsPDF icon  DOWNLOAD FORM
Clean Intermittent Self-Catheterization (Female) PDF icon  DOWNLOAD FORM
Clean Intermittent Self-Catheterization (Male) PDF icon  DOWNLOAD FORM
Diet Clear Liquid PDF icon  DOWNLOAD FORM
Diet Full Liquid PDF icon  DOWNLOAD FORM
Diet Low Oxalate PDF icon  DOWNLOAD FORM
Cystoscopy and Ureteroscopy PDF icon  DOWNLOAD FORM
Home Care of Your Ureteral Stent PDF icon  DOWNLOAD FORM
Hydrocele and Spermatocele Information PDF icon  DOWNLOAD FORM
Hypospadias PDF icon  DOWNLOAD FORM
Kegels How To Do Pelvic Muscle Exercises PDF icon  DOWNLOAD FORM
Mitomycin-C Bladder InstillationPDF icon  DOWNLOAD FORM
Neobladder Home Care Instructions PDF icon  DOWNLOAD FORM
Penile Injection Information Sheet PDF icon  DOWNLOAD FORM
Prostatitis PDF icon  DOWNLOAD FORM
Suprapubic Catheter Home Care (SP Tube) PDF icon  DOWNLOAD FORM
Undescended Testes (Cryptorchidism) PDF icon  DOWNLOAD FORM
Prostatectomy Da Vinci Robotic PDF icon  DOWNLOAD FORM
Prostatectomy Retropubic Radical PDF icon  DOWNLOAD FORM
Prostate Ultrasound and Biopsy InstructionsPDF icon  DOWNLOAD FORM

Post Operative Instructions

Many times after surgical procedures patients have a difficult time recalling the discussion of postoperative care. The following forms will help you with most of your concerns. Please feel free to contact us with any questions pertaining to your postoperative care.

Form DescriptionDownload
AdrenalectomyPDF icon  DOWNLOAD FORM
Artificial Urinary Sphincter - Inflatable Penile ProsthesisPDF icon  DOWNLOAD FORM
Bladder Suspension Post-Op PDF icon  DOWNLOAD FORM
Circumcision Post-Op PDF icon  DOWNLOAD FORM
(ESWL) Post-Op PDF icon  DOWNLOAD FORM
Holmium Laser Enucleation of Prostate Post-Op PDF icon  DOWNLOAD FORM
Nephrectomy and Renal Cryotherapy Post-Op PDF icon  DOWNLOAD FORM
Male Sling PDF icon  DOWNLOAD FORM
Male Sling for Incontinence PDF icon  DOWNLOAD FORM
Nephrectomy Post-Op PDF icon  DOWNLOAD FORM
Percutaneous Nephrolithotomy Post-Op PDF icon  DOWNLOAD FORM
Prostate Ultrasound and Biopsy Instructions PDF icon  DOWNLOAD FORM
PVP Post-Op PDF icon  DOWNLOAD FORM
Radical Cystectomy Post-Op PDF icon  DOWNLOAD FORM
Robotic and Radical Prostatectomy Post-Op PDF icon  DOWNLOAD FORM
Scrotal Surgeries: Orchiectomy, Hydrocele, Spermatocele and Varicocele Repair PDF icon  DOWNLOAD FORM
Transurethral Resection of a Bladder Tumor Post-Op PDF icon  DOWNLOAD FORM
Transurethral Resection of Prostate Post-Op PDF icon  DOWNLOAD FORM
Vaginal Sling and TVT Post-Op PDF icon  DOWNLOAD FORM
Vasectomy Post-Operative Instructions PDF icon  DOWNLOAD FORM
Vasovasotomy (Vasectomy Reversal) Post-Op PDF icon  DOWNLOAD FORM

Five Valleys Urology is Moving!

Starting 4/27, our offices will be located at:

2875 Tina Avenue, Suite 101
Missoula, MT 59808
Map Link »

Please note the following dates:

We will be closing our current North Office (601 W Spruce St Ste G) on 4/22/11.

The South Office (2831 Fort Missoula Rd - Physician Center II, Ste 105) will remain open until 4/26/11.

We'll begin seeing patients in our new office beginning 4/27/11.

Please Contact Us with any questions. We look forward to showing you our new space!