Patient Forms & Incentive Program


 

OFFICE POLICIES, AGREEMENTS & REGISTRATION FORMS

Up to $100 discount toward your first visit


LA Integrative GI Registration Form - Version 2017
Incentive Discount: $30 credit if you complete this form prior of your arrival to our office.

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Online Communication Rules of Engagement - Version 2017
Incentive Discount: $10 credit if you complete this form prior of your arrival to our office.

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Notification and Discussion of Results - Version 2017
Incentive Discount: $10 credit if you complete this form prior of your arrival to our office.

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Medical History Form (Paper Format) - Version 2017
Incentive Discount: $20 credit if you complete this form prior of your arrival to our office.

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"Must Read" Page (last updated February 2017)
Incentive Discount: $30 credit when you acknowledge that you have reviewed this section of the website(required).

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CONSENT FORMS

Up to $100 discount toward your first visit


Telephone or Video Conferencing Consent

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Colonoscopy and Endoscopy General Consent Information

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AthenaHealth Patient Portal Terms and Conditions

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DISCLOSURES & DISCLAIMERS


Disclosures & Disclaimers Prior to Endoscopy and Colonoscopy Surgery Scheduling

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Disclosure & Disclaimers on Lab Testing

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ADDITIONAL DOCUMENTS


Third Party Billing & Guarantor Agreement

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Patient Request for Medical Records

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Current Medications & Supplements

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Physician Supervised Consultation

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Location
Los Angeles Integrative Gastroenterology & Nutrition
2080 Century Park East, Suite 1804
Century City

Los Angeles, CA 90067
Phone: 310-289-8000
Fax: 310.203.4592
Office Hours

Get in touch

310-289-8000