• Skip to main content
  • Skip to footer

Laurence A. Levine, MD

Men's Health Specialist

Call Now (312) 563-5000

REQUEST AN APPOINTMENT

  • Home
  • Meet Dr. Levine
  • Men’s Health
    • Erectile Dysfunction
    • Low Testosterone
    • Peyronie’s Disease
    • Male Infertility
    • Chronic Scrotal (Testicular) Pain
    • Penile Size Enhancement
    • Aspiration & Sclerotherapy
  • Other Specialties
  • Contact Us

Request An Appointment

Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office at (312) 563-5000. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete.

Patient Registration Forms

Urologist Dr. Laurence Levine in Chicago, Illinois welcomes you to our practice. Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Completing the forms prior to your visit will help speed up the new patient registration process.

Please be sure to bring them with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another physician.

Downloadable Forms:

  • Chronic Scrotal Content Pain Symptom Index
  • Erectile Dysfunction Questionnaire
  • IIEF Survey for Erectile Dysfunction
  • PDQ Scale for Peyronie's Disease
  • Peyronie's Disease Patient Questionnaire
  • Premature Ejaculation Questionnaire

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.
Get Adobe Acrobat Reader

close up of doctor's hands filling out a form

Footer

Patient Education

PATIENT EDUCATION

We are devoted to empowering our patients with the information and patient education resources they need to understand their conditions better.

LEARN MORE

  • Home
  • Meet Dr. Levine
  • Men’s Health
  • Other Specialties
  • Contact Us
  • Patient Education
  • ADA Disclaimer
  • HIPAA Privacy Policy
  • Sitemap

Copyright © 2023 · UroPartners Urology Specialists LLC · All Rights Reserved

UroPartners Urology Specialists LLC
1725 West Harrison Street, Suite 352
Chicago, IL 60612
Phone: (312) 563-5000
Fax: (312) 563-5007

iHealthspot Medical Website Design and Medical Marketing by iHealthSpot.com

Board-certified urologist Dr. Levine offers the latest diagnostic and treatment techniques in our state-of-the-art Chicago office for a variety of urological conditions afflicting men, including ejaculatory disorders, Erectile Dysfunction, Low Testosterone, Peyronie’s Disease, Male Infertility, Chronic Scrotal (Testicular) Pain, Other Specialties