Patient Information

Our Office Policies

We have your convenience in mind. With the NEW online patient registration portal you can fill out your patient registration any time of day. Registering online will save time when you arrive for your appointment. This will ensure that you are seen as quickly as possible when you arrive for your appointment. Registration only takes about 10 minutes. Before you start the registration process, have your medical  insurance cards at hand. Fill out the information as accurately and completely as possible. You must fill out all required fields for the registration process to be complete. If you have any questions call our office at 413-241-2100.

Office Hours

For information or to schedule an appointment, please call us at 413-241-2100.

Appointments & Cancellations

With the exception of serious emergencies, it is expected that you keep all of your appointments. If you need to reschedule an appointment we require 24 hours notice. In such a case, please call our office and arrange for a make-up appointment with one of our patient care coordinators.

Emergencies

In the event of a medical emergency, please dial 911.

Insurance Plan Information

Payment

The Pioneer Valley Urology, P.C. accepts cash and personal checks as well as the following credit cards:

• American Express
• Visa
• MasterCard
• Discover
• Care Credit

All co-payments and deductibles are due at the time of service. This includes payment for any surgical procedures, which is usually taken care of in advance.

We are now able to keep your credit card on file to cover any out of pocket costs not covered by your insurance plan. 
 

Disclosures

•  Notice of Privacy Practices Omnibus Rules PVU .pdf
•  Your Rights and Protections Against Surprise Medical Bills.pdf

Forms

The Pioneer Valley Urology, P.C. provides our patients with office forms for your convenience. We recommend you print and fill these forms prior to your appointment to save time.

•  Medical History Form 2p.pdf
•  female bladder health history.pdf
•  New Patient History Form - female.pdf
•  Prostate Symptoms Questionnaire - Spanish.pdf
•  Sexual Health Inventory for Men (SHIM).
•  medical records release.docx
• pvu pt acknowledgement of receipt of privacy practices consent (hipaa).docx
•  Pt Demographics Form.pdf
•  patient financial agreement 2021.pdf

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