Patient Resources
Patient Forms
Save time at your appointment by completing these forms in advance. Bring them with you on the day of your procedure.
📋
New Patient Registration
Basic demographic and contact information for new patients.
Download PDF →📝
Medical History Form
Your medical history, current medications, allergies, and past procedures.
Download PDF →✍️
Informed Consent — Colonoscopy
Acknowledgment that you understand the procedure, its risks, and alternatives.
Download PDF →✅
Informed Consent — EGD
Acknowledgment that you understand the upper endoscopy procedure.
Download PDF →🔒
HIPAA Privacy Notice
How your medical information is used and protected under federal law.
Download PDF →💳
Financial Policy
Our payment and cancellation policies, including our all-inclusive pricing.
Download PDF →What to Bring to Your Appointment
- 1. Photo ID — driver's license, state ID, or passport
- 2. Insurance card — if you have insurance (even though we offer cash-pay pricing)
- 3. Completed forms — if you filled them out in advance
- 4. List of current medications — including dosages and frequency
- 5. Your driver — you cannot drive yourself home after sedation
- 6. Payment — we accept cash, credit/debit cards, and CareCredit
Have questions about the forms?
Call (913) 379-3350