Sheldon J. Freedman, MD Ltd.

Services

• Erectile Dysfunction
• Benign Prostatic Hyperplasia (BPH) / Enlarged Prostate
• Incontinence
• Overactive Bladder
• Interstitial Cystitis
• Urolithiasis
• Prostate Cancer
• Testosterone Deficiency
• Vasectomy

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Patient Information

Your First Appointment | Patient Forms
Insurance and Payment Information | Privacy Practices

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

• A picture ID
• Your insurance card
• Referral form if required by your insurance provider
• X-ray or other test results related to your condition
• Information about your medical or surgical history that pertain to the reason being seen
• Completed forms from this website (below)

Patient Forms

For your convenience, forms for your appointment are available online to review and complete in the convenience of your own home. When noted, these forms can be filled electroncally before printing. If you are scheduled for an appointment with us, please complete and print the appropriate forms below. Fax the completed forms to our office at (702) 369-6981 or bring them with you to your appointment.

Forms for New Patients

All new patients are required to complete the following forms. Please complete and print the following prior to your first visit to save time in the waiting room.

• Patient Registration [Electronically-fillable PDF]
• Patient Authorization to Release Protected Health Information [Electronically-fillable PDF]
• Patient History [Electronically-fillable PDF]
• Review of Systems [Electronically-fillable PDF]
• AUA System Score Profiles [Electronically fillable PDF]

The following forms are now paperless. Please read them carefully and you will sign them electronically at your first visit.

• Financial and Office Policy [PDF]
• Patient Consent for Use and Disclosure of Protected Health Information [PDF]
• Health Information & Privacy Policy [PDF]
• Notice of Privacy Practices [PDF]

PLUG-IN REQUIRED: To view the PDF documents above, you will need the Adobe Acrobat Reader® plug-in. If you do not have it already installed, a free version is available through the Adobe website. Download the Acrobat Reader.

Forms for Returning Patients

All returning patients are required to complete the following forms if they have not been completed within the past 12 months. Please complete and print these forms prior to your visit to save time in the waiting room. These forms are required by Dr. Freedman even if no changes have been made since the last update.

• Patient Registration [Electronically-fillable PDF]
• Review of Systems [Electronically-fillable PDF]
• AUA System Score Profiles [Electronically fillable PDF]

PLUG-IN REQUIRED: To view the PDF documents above, you will need the Adobe Acrobat Reader® plug-in. If you do not have it already installed, a free version is available through the Adobe website. Download the Acrobat Reader.

Insurance and Payment Information

Sheldon J. Freedman, MD Ltd. is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

A copy of our Notice of Privacy Practices will soon be posted on this website.

What's New

This is where you can feature something special about the practice, highlight a new service, link to a news article, etc.

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This is where you can feature something special about the practice, highlight a new service, link to a news article, etc.