Patient Forms

In order to expedite the check-in process during your upcoming appointment or procedure, you can download or fill out the forms below, as they relate to your appointment. * PLEASE PRINT THE FORMS  to bring to the center (these forms will not be saved online.)

If you are scheduled for an office visit, please fill out the forms under RMG Office. If you are scheduled for a procedure at one of our Endoscopy Centers, please fill out the forms under RMG Endoscopy Center.

Be sure to read the information carefully and bring all completed documents with you to your appointment. Remember to bring a photo I.D. and your current insurance card.

RMG Office Forms
Patient Info and Health History
Medical Records Release and HIPAA Authorization
Patient Consent for Use and Disclosure
Patient Contact Information
Insurance and Financial Policies
Uninsured Financial Policy
Notice of Privacy Practices

RMG Endoscopy Center Forms

RMG Dietitian/Nutritonist Forms
Dietitian Intake Form
Food Journal

If you have any questions at all about these forms or your appointment, please call the office where your appointment is scheduled. If you need to reschedule your appointment, please call at least 48 hours prior to your scheduled time.