We welcome you to our practice for your upcoming appointment.
Save time in the waiting room! Please print and complete the forms below prior to your appointment. You may mail, fax, or bring these forms with you.
- Patient Registration Form
- Financial Policy
- Review of Systems
- Medical Records Request
- Medication List
- Personal / Family History
- Patient Rights - Patients having procedures performed at the Northeast Endoscopy Center should download, print, read, complete the following form, and bring the signed copy with you to your procedure. Be sure to date the form the day you download and read it; this should be prior to your procedure date.
- HIPAA Notice of Privacy Practices
- Patient Record of Disclosures
If your insurance plan is an HMO or POS, please notify your Primary Care Physician so they can process your referral.
If you have medical records/labs that our doctors may need to review, please have these faxed to the specific office.
Bring to Your Appointment
In addition to the forms, please also bring the following items with you:
- Picture ID
- Insurance cards
- Referral, if required
- Medical records
- Request Appointmentconvenient online request form available 24/7
- Online Bill Paymentpay your bill online when it's convenient for you
- Secure Patient Portalsecure online portal for our established patients
- Access Patient Formssave time by completing forms before your appointment
- Insurance Acceptedsee a list of the insurance plans accepted by our practice