At Yakima Urology Associates, we pride ourselves on delivering the finest medical care possible
2500 Racquet Lane, Suite 100 Yakima, WA
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Download the YUA Patient Form

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Patient Financial Responsibility Statement

View Statement

To submit this form, follow these 3 steps:

  • Download the form to your computer
  • Open and fill out the form (note, we suggest you save several times in the course of filling out the form as it is a long form)
  • Attach it to an email and send it to medicalrecords@yua.com

Note:

If you prefer, print out the completed form and mail or bring it in to:

Yakima Urology Associates PLLC
2500 Racquet Lane, Suite 100
Yakima, WA 98902
(509) 249-3900
Fax: (509) 573-9539



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