Outpatient

Riley Pediatric Urology

4.7 out of 5 stars

(46 ratings)

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Pediatric Outpatient Center
 4935 W. Arlington Rd., Suite A
Bloomington, IN 47404

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Hours

Open until 4:30 pm

Sun: Closed
Mon: 8 am - 4:30 pm
Tue: 8 am - 4:30 pm
Wed: 8 am - 4:30 pm
Thu: 8 am - 4:30 pm
Fri: 8 am - 4:30 pm
Sat: Closed

*Location also offers Lab

Free Surface Parking

Free surface parking is available outside the building. Get Directions

Riley Physicians Pediatric Urology provides the following forms for parents, healthcare providers and personnel. We have also curated relevant resources from other websites and provided links with brief descriptions of the information that is available.

Authorization to Release Medical Records

Complete this form when you’d like for medical records to be released to another entity.

Consentimiento General (Español)

Se le pedirá que revise y firme este consentimiento para recibir atención de nuestros médicos y personal.

Consentimiento Para Comunicaciones Preferidas (Español)

Complete este formulario para permitir que familiares y amigos puede recibir información sobre su salud.

General Consent (English)

You will be asked to review and sign this consent to receive care from our physicians and staff.

Preferred Communication List (English)

Complete this form to allow family and friends to receive information regarding your health.

  • Your child’s current insurance information
  • Form of identification
  • List of all medications your child is currently taking, including how many times per day and the dose (be sure to include both prescription and over-the-counter medications)
  • List of questions or concerns for your child’s doctor
  • Medical records (e.g. X-rays, lab test results, etc.)—your referring physician may have already sent these records, so be sure to ask your doctor before your child’s visit with us
  • Form of payment for any deductible and/or co-insurance required by your insurance plan

We provide multispecialty care for a number of conditions. Below are links to our related departments.