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Need to cancel an appointment or communicate with our office?
E-mail us at customerservice@canyonstateurology.com
You will receive a response with 24-48 hours.
No medical questions please.
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What to Bring to Your Appointment | Preparing for surgery
Insurance and Payment Information
New Patient Forms & Privacy Notice | Hospital Affiliations

What to Bring to Your Appointment

• Your insurance card
• Physician referral forms if required by insurance
• New patient packet or vasectomy packet
• A list of current prescriptions and/or over-the-counter medications you are taking, including dose and frequency
• Pertinent information about your medical and surgical history
• Any recent x-rays or appropriate records you may have

Preparing for Your Surgery

• Surgery Schedule Information

Insurance and Payment Information

Canyon State Urology is a participating provider with Medicare and most major insurance plans. Please contact us at the number below if you would like to verify our participation with your insurance. For specific questions regarding your individual coverage and benefits please contact your insurance company.

We require payment of your co-pay or coinsurance at the time of service. When necessary, our staff will work with patients who require a payment plan. Payment plan issues should be discussed with our billing department prior to services being rendered.

Some surprises are not enjoyable. Prior to your appointment please review our Financial Policy (PDF). [Help with PDF forms]

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New Patient Forms & Privacy Notice

To save time, please take a moment to print and complete the forms below to bring with you to your initial visit.

[Help with PDF forms]

• New Patient Packets:
  • Male
  • Female
  Print and complete if you are a new patient to either of our offices.
  
  
• Vasectomy Packet
  Print and complete if you are seeing our physicians for a vasectomy procedure only.
  
  
• Notice of Privacy Practices & Consent Forms
  
  
• Post-Op Instruction Sheet

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Hospital Affiliations

Our physicians have staff privileges at the following facilities:

• Pinnacle Surgery Center
  6790 W Thunderbird Rd
  Peoria, AZ 85381

• Arrowhead Hospital
  Phone: 623.561.1000
  18701 North 67th Avenue
  Glendale, AZ 85308
  
  
• Banner Thunderbird Medical Center
  Phone: 602.865.5555
  5555 W. Thunderbird Road
  Glendale, AZ 85306
  
  

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Canyon State Urology

Tel: 602.375.1700
Fax: 602.978.1225
www.canyonstateurology.com