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

Download the YUA Patient Form

Download Form

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

HIPPA Notice

Download Form Descargar Formulario


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