The information requested in this form will be used for the purpose of scheduling an appointment. Providing the information requested does not imply or establish a doctor/patient relationship, and does not subject the information provided to the provisions of the Health Insurance Portability and Accountability Act (HIPAA). If/when you establish a doctor/patient relationship with NEO Urology Associates, Inc., you will be provided with a copy of the NEO Urology Associates, Inc. Privacy Policy. It can also be accessed on this website, here.