California Urologist Dr. Shahram Shawn Gholami

Patient Resources

We have provided you will this section to help navigate you to the appropriate information. Below are helpful education links to better educate you on your medical condition or procedure you are preparing for. If you have any further questions that are not answered for you by visiting our web site, please contact us directly (408) 358- 2030. Thank You!

About Your Visit- Preparation

What to Bring to Your Appointment

Please bring with you the following:

  • Your insurance card
  • Physician referral forms
  • 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 record ( Please bring actual X-Rays if possible )

Patient Forms

Please download, print and complete the following forms for preparation for your appointment.

NOTE: Documents below are pdf's and open in a new browser window.

Patient Registration

Financial Policy

Fertility Policy

Pre/Post Operative Instruction forms

NOTE: Documents below are pdf's and open in a new browser window.

Billing and Insurance

Our office contracts with most insurance companies. Your Insurance company provides you with proof of insurance that must be presented prior to all services. We bill all primary insurance plans for our patients. Payment for co-payments, deductibles, and payment for any non-covered service is required at the time of your visit. If you have no insurance, your account will be treated as a cash account and we will collect payment in full at the time of service. For your convenience we accept check, cash, Visa, and Master Card.

Your individual insurance plan is an agreement between you and your insurance company. It is necessary for you to know the specific details of your plan. If your plan requires a referral for specialty services, it is especially important to notify us if there are restrictions on referrals to outside facilities for services. It is your responsibility to arrange for all appropriate referrals and authorizations required for insurance payment. You will be liable for all charges billed for outside providers if they are not contracted with your plan and you have not received the proper pre-authorization. It is your responsibility to know if you referral has expired and to obtain a new referral if needed.

Download our Financial Policy (PDF opens in new browser window)