OFFICE POLICIES, AGREEMENTS & REGISTRATION FORMS Up to $100 discount toward your first visit
Form
Printable
Electronic
LA Integrative GI Registration Form - Version 2017 Incentive Discount: $30 credit if you complete this form via Adobe Sign, at least 8 hours prior to visit(required).
PDF
Online Communication Rules of Engagement - Version 2017 Incentive Discount: $10 credit if you complete this form via Adobe Sign, at least 8 hours prior to visit (optional).
PDF
Notification and Discussion of Results - Version 2017 Incentive Discount: $10 credit if you complete this form via Adobe Sign, at least 8 hours prior to visit(required).
PDF
Medical History Form (Paper Format) - Version 2017 Incentive Discount: $20 credit if you complete this form & fax it to (310) 553-5590 prior to your visit. Please bring the original with you on first visit(required).
PDF
N/A
Medical History Form (Electronic Format) - Version 2017 Incentive Discount: $20 credit if you complete this information through the Patient Portal or by using the iPad at the LA Integrative office prior to your appointment(optional).
N/A
"Must Read" Page (last updated February 2017) Incentive Discount: $10 credit when you acknowledge that you have reviewed this section of the website(required).
N/A
CONSENTS
Form
Printable
Electronic
Telepone or Video Conferencing Consent for New Patients
PDF
Telephone or Video Conferencing Consent for Established Patients
PDF
Colonoscopy and Endoscopy General Consent Information
PDF
AthenaHealth Patient Portal Terms and Conditions
PDF
DISCLOSURES & DISCLAIMERS
Form
Printable
Electronic
Disclosures & Disclaimers Prior to Endoscopy and Colonoscopy Surgery Scheduling
N/A
Disclosure & Disclaimers on Lab Testing
N/A
ADDITIONAL DOCUMENTS
Form
Printable
Electronic
Third Party Billing & Guarantor Agreement
PDF
N/A
Patient Request for Medical Records
PDF
N/A
Current Medications & Supplements
PDF
N/A