Billing Policies - Potomac Urology 2026

1. Click ‘Get Form’ to open the Billing Policies - Potomac Urology document in the editor.
2. Begin by reviewing the 'Assignment of Benefits' section. Here, you will need to acknowledge your understanding of financial responsibilities and authorize Potomac Urology Center to handle insurance communications on your behalf.
3. Next, navigate to the 'No Show Fee' policy. Ensure you understand the cancellation requirements and fees associated with missed appointments. You may want to note these fees for future reference.
4. If applicable, check the 'HMO Patients' section. Confirm that you have obtained any necessary referrals from your primary care physician before your visit.
5. In the 'Privacy Notice' section, read through the privacy practices and indicate your consent by signing in the designated area. Make sure to provide your printed name, date of birth, and today's date.
6. Finally, review all entered information for accuracy before submitting or saving your completed form.

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