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Standard Form Packets
Please download, print and complete the form packets for your visit as directed by our office staff.
These packets contain information for you about your scheduled visit or procedure, and forms you should use to provide us with information we need about you. As a Medicare-certified Ambulatory Surgical Center federal regulations require us to provide you with these notices and disclosures in advance of the date of your procedure.
New Clinic Patient. This packet is for new patients scheduled to be seen in our clinic.
Open Access Upper Gastrointestinal Endoscopy (EGD). This packet is for patients scheduled to undergo upper endoscopy who have been interviewed by one of our registered nurses. In most cases all of the information and forms you will need are included in this packet.
Open Access Colonoscopy. This packet is for patients scheduled to undergo colonoscopy who have been interviewed by one of our registered nurses. In most cases all of the information and forms you will need are included in this packet. Please discard any "prep instructions" provided by you pharmacy or another health care provider and follow the instructions in this packet.
In some cases our staff may direct you to use an alternate method of cleansing your colon. You may download the alternate preparation instructions as directed below, and use them in place of the instructions included in the standard packet above. All other pages of the standard packet will apply.
Open Access Bidirectional Endoscopy - Upper Gastrointestinal Endoscopy (EGD) and Colonoscopy. This packet is for patients scheduled to undergo EGD and colonoscopy under the same sedation who have been interviewed by one of our registered nurses. In most cases all of the information and forms you will need are included in this packet. Please discard any "prep instructions" provided by you pharmacy or another health care provider and follow the instructions in this packet.
In some cases our staff may direct you to use an alternate method of cleansing your colon. You may download the alternate preparation instructions as directed below, and use them in place of the instructions included in the standard packet above. All other pages of the standard packet will apply.
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