Forms & Instructions
If you are experiencing any symptoms you will need to see one of our physicians for an office visit before any tests or procedures can be scheduled. We do not have any forms that need to be filled out for your new patient visit. However, it is helpful if you sign up for the Patient Portal prior to your visit.
ON THE DAY OF YOUR APPOINTMENT, PLEASE BRING:
- Your Insurance card and driver's license
- Current List of Medications
- Your list of questions or concerns
- Your co-pay
Screening Colonoscopy Patient Forms
For your convenience, an office visit is not necessarily required prior to scheduling a screening colonoscopy. Please complete the following forms and return to our office to request a screening colonoscopy.
*please note if you are having any GI symptoms please call the office as you will need an office visit first.
If you need to schedule a screening colonoscopy
You need to fill the medical history form and send it back to us to be reviewed by our doctors.
- You can send us the completed form via
- Mail to 5701 Bow Pointe Dr., Ste. 370, Clarkston, MI 48346
- Fax at 248.625.4085
- E-mail to [email protected]
- In person at our Clarkston location
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.
Instructions for ENDOSCOPIC PROCEDURES
- Flexible Sigmoidoscopy
- Video Capsule Endoscopy
- 48 hr BRAVO pH test off medication
- 96 hr BRAVO pH test off medication + on medication