Since you will be traveling to Miami for your procedure, our staff can assist in making your trip and procedure as easy as possible. The following steps and paperwork will help expedite the logistics of your procedure.
Patient Checklist (All patients must complete the following, prior to surgery)
_____Please let the practice/office know a few weeks in advance the date you would like your surgery.
Initial evaluations are scheduled for either Tuesday (with surgery the following Wednesday) or Thursday (with surgery the following Friday). We suggest one local hotel which is very nice & close to the office/hospital; The Sonesta Hotel. For more information click here _____ Please plan on being in Miami for 5-7 days. _____ Please inform the practice of your itinerary & confirm your hotel reservation two-to-three weeks before your appointment.
Below you may print our package for new patients. These forms are required to open a chart for you. _____Please complete the forms & bring to your initial visit or send the documents electronically prior to your visit. (The consent forms will be signed in our office after your consultation with Dr. Perito.)
Pre-Op Tests & Clearance
_____Please provide a medical clearance from your internist. Pre-op testing required includes:
CBC, PT, PTT, BMP, URINE ANALYSIS, CHEST X-RAY, EKG AND MEDICAL CLEARANCE LETTER (the medical clearance is valid up to 30 days prior to surgery)
If you are unable to obtain medical clearance please contact our office to discuss pre-operative requirements.
If you have any history of cardiac issues, we also request a cardiac clearance.
*If you are an international patient and unable to obtain medical clearance from a licensed, U.S. physician please contact our office for assistance.
Insurance & self-pay information
_____ If you have insurance, please forward the following…
- Full Name on Policy
- Date of Birth
- Member #
- Group #
- Telephone # for Insurer
_____ * If possible, scan & attach a copy of your ID/Insurance card.
* If you do not have insurance, please contact us directly for the cost of your procedure @ (786)369-8970
For more amenities surrounding your care you may also visit the “concierge care” section at peritourology.com.
Please contact our office directly with any further questions or email your request through the “contract” section at peritourology.com. Thank you for helping to expedite your visit by completing the paperwork in advance.
PATIENT INFORMATION PACKAGE – Click here to view and print
To print this page click here.