Patient Center
Patient Forms
Please print and complete the forms packet below before your appointment and bring them with you to your appointment.
Patient Forms Packet
- Patient Forms
- HIPAA Notice of Privacy Practices (print for your records)
Individual Forms
If you need an individual form, please choose from the list below.
- Patient Information
- Patient Health Information Disclosure
- Review of Systems
- Medical History
- Family History
- HIPAA Request for Restrictions of Health Information
- HIPAA Notice of Privacy Practices (print for your records)
Procedure Instructions
Colonoscopy Prep Instructions
- SUPREP Colonoscopy Prep Instructions
- CLENPIQ Colonoscopy Prep Instructions
- MIRALAX Colonoscopy Prep Instructions
- Pre-surgical Patient Questionnaire - Print and complete this form, and bring with you the day of your procedure.
Colonoscopy Prep Instructions
Insurance Accepted
If you don't see your plan listed, please contact our office. The managed care health insurance market changes rapidly, and specific coverage questions should be discussed directly with your insurance company or our knowledgeable staff.
In-Network
- BCBS of Alabama
- Beech Street
- Coventry Healthcare
- Healthchoice
includes Aetna in Alabama - Tricare - Tricare Prime
requires referral from primary care physician - United Healthcare
- Medicaid
requires referral from first provider
Medicare Plans
- Medicare
- Viva Medicare
- Healthsprings
- Blue Advantage
We will file any insurance but the patient will be responsible for deductible/coinsurance amounts.