Patient Forms
Please print and fill out these forms so we can expedite your first visit:
Please remember to bring in your insurance card, photo ID, and a referral if it is required by your insurance.
- Patient Registration
- Patient Financial Responsibility
- Patient Consent Form
- Privacy Notice
- Office Policies
Endoscopy Center Forms
Insurance / Billing
We participate with most insurance companies, including:
Please call our office to verify acceptance of your insurance plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure. We are happy to file insurance for your reimbursement as long as you are free to choose your own gastroenterologist.
Referrals are patient responsibility. If you do not have your referral or if your primary physician did not enter one into the system, you will be rescheduled for your appointment.
- Aetna
- Amerihealth
- Cigna
- CHN
- Devon
- Magna Care
- Medicare
- Oxford
- United Heatlhcare
- Qualcare
- Great West
- Multi Plan
- Horizon (some Horizon plans we do not participate with so please have your card available when making an appointment
Payment Options
We accept cash, check, and credit cards. Payment schedules can be discussed with our billing staff.
Prescription Refills
Please notify us of your preferred pharmacy. Most prescriptions will be sent electronically to your pharmacy, so if we have the correct information, refills can be efficiently processed. . Please use the Patient Portal to request a prescription refill or call the office for prescription refills during regular office hours. We cannot call in prescription refills during nights and weekends. Prescriptions will usually be sent to your pharmacy within 24 hours. Please allow time for processing and contact your pharmacy to verify that a prescription has been renewed before you proceed to the pharmacy. Please contact us if the prescription has not been renewed in a timely fashion.