Patient Forms

You now have 2 options for filling out your Patient Forms.
Please choose from either option 1 or option 2.

 

Fill out the forms online before you come, with our secure Patient Portal Log-in and then complete the medical history online.

Complete Option 1 with these 4 easy steps

Step 1 Call 205-271-8000 and set up your appointment. (Provide your email address when making your appointment, you will be emailed an invitation to join our Secure Patient Portal)

Step 2 Access the Portal following the steps in the invitation. You will be prompted to create a unique ID and password.

Step 3 Sign in with the user id and password you created. Once you login, you can access your Secure Patient Portal account at any time.

Step4 Provide and submit all requested information.

 

Print out and complete the patient forms before you come, and also fill out the medical history online.

Complete Option 2 with these 2 easy steps

Step 1 Print out all GENERAL patient forms. All forms are listed below.

Step 2 Fill out all GENERAL patient forms and bring them with you to your appointment. (Please note: you cannot print the medical history form from the link with the red folder. You must complete this form online. If you bring the printed medical history form with you it cannot be used. This form has to have special paper and be scanned in, so the printed from will not be valid.)

Step 3 Complete the medical history form online before your office visit. You can complete the medical history form by going here:
Online Patient Medical History Form

*Make sure to mark each section and if none of the conditions apply, please check none.

*If you do not complete the online form, please arrive 30 minutes early to complete the hard copy form.

*Please do not add any hyphens, or apostrophes to your name as this will prevent the form from completing.

* Please call your physician for instruction on which prep he requires for your procedure.

Procedure Prep Forms
1. Test Prep (General Information): Open/Print
2. Movi Prep: Open/Print
3. Miralax Prep: Open/Print
4. Trilyte Nulytely Prep: Open/Print
5. Trilyte Prep/Low Volume Prep: Open/Print
6. Rectal EUS Prep: Open/Print
7. Sigmoidoscopy Prep: Open/Print
8. Esophageal Motility Information: Open/Print
9. Halflytely/Bisacodyl Prep: Open/Print
10. Suprep: Open/Print
11. Prepopik: Open/Print
12. Prepopik Split Dose: Open/Print
Business Office – Forms
Collection Policy: Open/Print
Financial Policy: Open/Print
Advance Beneficiary Notice(ABN): Open/Print
Medical Release
Medical Release Form (Authorize Info To Another Office or Doctor): Open/Print
Medical Release Form (Authorize Another Office or Doctor to Send Info to Us – BGA): Open/Print
General Patient – Forms
Open and Print All New Patient Form (Contains all Patient Forms) Open/Print
Privacy Policy – HIPAA: Open/Print


Additional Good Questions for Good Health Information can be found here.