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Northwest Urological Associates

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Directions | Initial Visit | Patient Forms
Insurance | Hospital and Facility Affiliations
Privacy Practices


Located between Golf and Algonquin Roads in Arlington Heights, the office is easily accessible from Route I-90. (View map)

Initial Visit

Atrium On your initial visit, please arrive 15 minutes before your scheduled appointment. You will need to provide us with a brief medical history that should include any medical conditions you have or may have had in the past. Your history will need to include the following:

You will also need to bring any actual recent xrays (not reports) related to your condition, as well as any medical records from previous physicians you have seen or from a physician who is referring you to Northwest United Urology, LLC. In addition, if your insurance company requires that you bring a referral or have a referral number for your visits to specialists, you should contact your Primary Care Physician for your referral prior to your specialist visit with us.

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Patient Forms for New Patients

As a new patient, you will find it extremely helpful to download the following forms, which Northwest United Urology, LLC physicians will need for your initial visit. Please complete these forms at home before your visit. If you do not understand any part of any of the forms, you can just leave it blank and complete it after you arrive at the office. The forms you will need to download for information and completion are:
[PDF help]

Additional Patient Forms

Other forms that may be helpful to you are:

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The physicians at Northwest United Urology, LLC are credentialed with numerous insurance plans, including, but not limited to the following:

  • AARP
  • Aetna Healthcare
  • Beech Street
  • Cigna Healthcare
  • Coventry Healthcare
  • Great West
  • Health Dynamics PPO
  • Healthspring
  • HFN
  • HFN
  • Humana Healthcare
  • Medical Care Group
  • Multiplan/PHCS
  • Preferred Network Access
  • Preferred Plan PPO
  • Three Rivers Provider Network
  • United Healthcare

Northwest United Urology, LLC accepts Medicare assignment. Upon presentation of an insurance card at the time of your visit, we will file an insurance claim for you with your primary and secondary insurances.

If you do not have an insurance card with you at the time of your visit, payment in full is expected. If necessary, payment plans can be arranged for large balances provided that at least one-half of your bill is paid at the time of your visit.

If you have questions regarding insurance coverage for procedures performed at our office or at one of the local medical centers at which we perform surgery, please call the telephone number on your insurance card to verify our participation in your personal insurance plan.

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Hospital and Facility Affiliations

Hospital Affiliations

Northwest Community Hospital
800 W. Central Road
Arlington Heights, IL 60005

Alexian Brothers Medical Center
800 W. Biesterfield Road
Elk Grove, IL 60007

St. Alexius Medical Center
1555 Barrington Road
Hoffman Estates, IL 60169

Other Affiliations

United Shockwave Services
1111 E. Touhy
Des Plaines, IL 60018

Chicago Prostate Cancer Center
815 Pasquinelli Drive
Westmont, IL 60559

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Privacy Practices

Northwest United Urology, LLC makes available to every patient a copy of our current Notice of Privacy Practices. Our office asks each patient to sign a Notice of Privacy Practices Acknowledgment (*pdf form), stating that he or she has read and is aware of our Notice of Privacy Practices.

If a patient would like personal healthcare information released to anyone other than himself, Northwest United Urology, LLC provides a Patient Authorization Form (*pdf form). By using this form, patients may designate who, besides themselves, may receive information regarding their confidential medical information.

Patients wishing to review their Northwest United Urology, LLC medical records may use the Patient Records Access Request Form (*pdf form) to request a review appointment. Chart reviews take place in our offices by appointment and with an Northwest United Urology, LLC representative present. If a patient wishes to amend his or her chart in any way, Northwest United Urology, LLC provides a Patient Request to Amend Records Form (*pdf form) for that purpose.

For further privacy information, please call the Office Manager at 847.439.4343.
*[click here for information on accessing and printing .pdf forms]

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Patient Information

Patient Forms




Our Providers

Daniel H. Piazza, M.D.

David A. Nellessen, M.D., F.A.C.S.

Michael L. Paik, M.D., F.A.C.S.

James C. Kim, M.D., F.A.C.S.

James W. Faulkner III, M.D.

Helen C. Ahn, M.D.

Phuong N. Huynh, M.D., M.P.H.

Melissa A. Krainson, PA-C