Patient Information

What to Bring to Your Appointment | Insurance
Emergency Care | Prescriptions and Renewals
Fees and Payments | Hospital Affiliations | Patient Forms

What to Bring to Your Appointment

  • Your insurance card
  • Physician referral forms, if required by insurance
  • List of prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about your medical and surgical history
  • Recent x-rays or relevant records
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Fragrance Free Environment

Our office is committed to creating a fragrance free environment for our patients & our staff. Fragrances from personal care products have been associated with adversely affecting a person’s health including headaches, upper respiratory symptoms, shortness of breath, and difficulty with breathing. We respectfully request that all visitors to this office refrain from using heavily scented personal products while at this office.


We will submit claims to your insurance company, however, it is your responsibility to pay any deductible, coinsurances or any other balance that is not covered by your plan.

Medicare patients are required by law to pay their annual deductible. HMO patients must obtain written pre-authorization from their primary physicians and are required to pay the co-payment at the time of service.

We know questions can arise on insurance matters and these should be discussed with our billing office. We will be happy to help you receive maximum benefits; however the agreement of the insurance company to pay for medical care is a contract between you and your insurance company.

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Emergency Care

We recognize that you can have an emergency situation arise, and we will do our best to respond to your problem promptly. In the event of a severe situtation, or one in which you are in doubt, go immediately to the emergency room of the nearest hospital and ask them to contact your urologist. If the situation is not that severe, but one where you wish to contact your urologist, please call our office and we will have your doctor call you back as soon as possible.

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Prescriptions and Renewals

All prescriptions and authorizations for renewals should be requested during normal office hours.

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Fees and Payments

We make every effort to keep down the cost of your medical care. You can help by paying upon completion of each visit. Other arrangements can be made with our office manager depending upon special circumstances.

If your insurance requires an office visit copayment, that copayment is due at the time of your visit. If our office has to bill you for your copayment, there will be a $10 billing fee attached to each statement sent.

Please note: Our office requires two business days (48 hours) notification for cancellation of *most* established patient Office Visits. A $25 charge will be implemented for failure to cancel scheduled appointments for follow up Office Visits, two business days prior to those established patient visits.

Also, failure to give two business days notice for NEW PATIENT CONSULTATIONS will result in a $75 charge.

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Hospital Affiliations

Dr. Glazier has affiliations with the following hospitals:

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Patient Forms