Please review, complete & sign the forms below at least 24 hours before your appointment.

OFFICE AGREEMENTS

FIRST: Please complete the form related to the doctor that you are visiting

1) Dr. Farshid Rahbar LA Integrative GI Registration Form
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

OR

1) Dr. Dipti Sagar Registration Form
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

SECOND: Complete the following forms

2) Online Communication Rules of Engagement
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

3) Notification and Discussion of Results
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

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

 

 

THIRD: Complete the MEDICAL HISTORY FORM

Medical History Form – Version 2025
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

 

FOURTH: Complete the SYMPTOM HISTORY FORM

Symptom History Form – Version 2025
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

 

FIFTH: Read and Learn more about the following:

  • MUST READ  VIEW
  • ABN Form AND General Information for Medicare Patients: VIEW
  • TERMS & CONDITIONS: AthenaHealth Patient Portal DOWNLOAD/PRINT PDF VIEW

 

SIXTH: Other Documents for Your Reference:

CONSENTS: 

1) Colonoscopy and Endoscopy General Consent Information DOWNLOAD/PRINT PDF VIEW

DISCLOSURES & DISCLAIMERS:

1) Disclosures & Disclaimers Before Endoscopy and Colonoscopy Surgery Scheduling
VIEW

2) Disclosures & Disclaimers – Procedure Request Form
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

3) Disclosure & Disclaimers on Lab Testing
VIEW

4) Disclosures & Disclaimers – Collaboration of Physicians
VIEW

 

ADDITIONAL DOCUMENTS:

1) Third Party Billing & Guarantor Agreement
DOWNLOAD/PRINT PDF

2) Credit Card Authorization
PRINT PDF  |  SECURE ONLINE FORM 

3) Patient REQUEST for Medical Records from Our Office
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

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

5) Procedure Request Form
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

6) Patient AUTHORIZATION for Release of Records from Other Sources to Our Practice
DOWNLOAD/PRINT PDF | Fill Out & Submit Online

7) Heidelberg Form
Fill Out & Submit Online