OFFICE POLICIES, AGREEMENTS & REGISTRATION FORMS
Up to $100 discount toward your first visit (New Patients)
Step 1- Complete below Forms: $50 Discount
Step 2- Complete pre-check in & Data Capture: $50 discount (Discount Applied to New Patients Only)
LA Integrative GI Registration Form – Version 2020
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Online Communication Rules of Engagement – Version 2020
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Notification and Discussion of Results – Version 2020
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Medical History Form (Paper Format) – Version 2020
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“Must Read” Page (last updated February 2020)
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CONSENT FORMS
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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Credit Card Authorization Form
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Procedure Request Form
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Request For Medical Records
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Heidelberg Form
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