Download Forms

New Patient Forms

These are forms that all new patients are asked to complete. Please check when making an appointment to see if any additional forms are required.

NEW PATIENTS: Please Fill-out, then print and bring this form with you to your appointment along with your photo ID and insurance card(s).

 

Other Useful/Individual forms:

Authorization to Release/Obtain Medical Records

Privacy Practices

Financial Policy

Patient Registration Form

Patient History Form

Preparation for Colonoscopy

Colonoscopy Prep

The preparation before the colonoscopy is just as important as the examination itself. The goal of colonoscopy prep is to eliminate all fecal matter from the colon so that the physician conducting the colonoscopy will have a clear view. There are several ways to achieve this based on your preference and general medical health. Here you will find downloadable instructions for your use. Please download the appropriate form based on the bowel preparation instructions and prescriptions we have given you.

All files are in PDF format. If you do not have Adobe Reader, you can download it here.

It is important to read these instruction very carefully at least one week before. You should know that if you do not, your colonoscopy may be impossible to complete safely or effectively. If you have any questions regarding the instructions or the forms to be filled out below, please call (480) 240-7391 or (623) 242-2020.

Preparation Instructions for COLONOSCOPY/COLON SURGERY Using Miralax-Gatorade

Preparation Instructions for COLONOSCOPY/COLON SURGERY using SUPREP. (Note: This will take you to the manufacturer’s website)