Dayton Physicians Urology Division

North Office
9000 North Main, Suite 333
Dayton, Ohio 45415
Tel: 937.832.8400
Fax: 937.832.8711
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South Office
400 North Main St., Suite B
Centerville, Ohio 45459
Tel: 937.434.1177
Fax: 937.434.9216
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East Office
We’ve Moved!
1911 N. Fairfield Road, Suite 300
Beavercreek, Ohio 45432
Tel: 937.429.7352
Fax: 937.429.3772
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Greenville Office
1191 Wayne Ave.
Greenville, Ohio 45331
Tel: 937.547.0153
Fax: 937.547.0615
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Central Office
30 E. Apple St., Suite 5258
Dayton, Ohio 45409
Tel: 937.208.2540
Fax: 937.208.2551
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Patient Information

What to Bring to the Appointment | Patient Forms
Hospital Affiliations | HIPAA Notice of Privacy Practices

What to Bring to the Appointment

A list of current prescriptions and over-the-counter medications, including dose and frequency
Information about the patient's medical and surgical history
Patient's insurance card

Patient Forms

If you are a new patient to Dayton Physicians Urology or have any changes since your last visit, please print and complete the following patient forms before your office visit:
[PDF Help]

Patient Registration Form (PDF)
Health History Form (PDF)
Authorization of Use and Disclosure (PDF)

Hospital Affiliations

Good Samaritan Hospital - Dayton, OH
Kettering Medical Center - Kettering, OH
Sycamore Hospital - Dayton, OH
Children's Medical Center - Dayton, OH
Miami Valley Hospital - Dayton, OH

HIPAA Notice of Privacy Practices

Our HIPAA Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.