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
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

Online Communication Rules of Engagement – Version 2020
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

Notification and Discussion of Results – Version 2020
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

Medical History Form (Paper Format) – Version 2020
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

“Must Read” Page (last updated February 2020)
VIEW


CONSENT FORMS

Telephone or Video Conferencing Consent
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

Colonoscopy and Endoscopy General Consent Information
DOWNLOAD/PRINT PDF VIEW

AthenaHealth Patient Portal Terms and Conditions
DOWNLOAD/PRINT PDF VIEW


DISCLOSURES & DISCLAIMERS

Disclosures & Disclaimers Prior to Endoscopy and Colonoscopy Surgery Scheduling
VIEW

Disclosure & Disclaimers on Lab Testing
VIEW


ADDITIONAL DOCUMENTS

Third Party Billing & Guarantor Agreement
DOWNLOAD/PRINT PDF

Patient Request for Medical Records
DOWNLOAD/PRINT PDF

Current Medications & Supplements
DOWNLOAD/PRINT PDF | Fill Out & Submit Online