What to Bring to Your Appointment | Patient Forms
Insurance and Payment | Hospital Affiliations

What to Bring to Your Appointment

• Your insurance card
• Physician referral forms if required by insurance
• A list of current prescription or over-the-counter medications you are taking, including dose and frequency
• Patient forms
• Any recent x-rays or appropriate records you may have.

Patient Forms

For your convenience, the following printer-friendly PDF patient forms can be printed out, completed and brought to your appointment.

• Patient Demographic Information
• Patient Medical History
• Medications Form (PDF)
• Men's Health Assessment Questionnaire - AUA Symptom Index
  
  
• Release of Information
• Consent for the Use and/or Disclosure of Protected Health Information
• Lifetime Authorization Insurance Assignments and Authorization to Release Information
• Notice of Privacy Practices
• Acknowledgement of Receipt of Notice of Privacy Practices
  
  
[PDF help]

Insurance and Payment Information

Matthew S. Lief, MD, PA, FACS is a provider for Medicare and most major insurance plans. We provide insurance billing. Anything not covered by insurance will be your responsibility.

We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. When necessary, our staff will work closely with patients who require a payment plan.

If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at the phone number below. Questions regarding your coverage and benefits should be directed to your employer or insurance company.

We accept the following insurances:

Hospital Affiliations

Dr. Lief has privileges at the following hospitals:

• Coral Springs Medical Center
• Northwest Medical Center
• University Community Hospital

Matthew S. Lief, MD, PA, FACS