Please fill out our new patient packet.

Download YUA Patient Form Packet

To submit your 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:

Patient Financial Responsibility Statement


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