Patient Forms

*Please read the following information carefully – all patients must bring a photo I.D. and current insurance card to all appointments.*

OFFICE VISITS — Rocky Mountain Gastroenterology is now using an electronic patient registration system for all office visits. You will receive a text and/or email 3 days prior to your appointment with a link to fill out the necessary information for your appointment.

  • If you do not receive the link, please check your junk folder, and then contact the office in which you are scheduled, and ask them to resend the link.
  • If you are unable to complete the online registration at home, please arrive to our clinic at least 20 minutes prior to your scheduled office visit and we will provide you with a tablet to complete the registration information.

PROCEDURE PATIENTS — in order to expedite the check-in process, please download the forms below as they relate to your appointment. PLEASE PRINT THE FORMS & bring to center (filled out forms will not be saved online.)

RMG Endoscopy Center Forms (please click on selection below):

  1. Patient Health History and Medication Reconciliation
  2. Medical Records Release and HIPAA Authorization Form
  3. Important Information Regarding Your Procedure
  4. Ownership Disclosure Statement
  5. Patient Consent for Use and Disclosure
  6. Patient Contact Information
  7. Patient Rights & Responsibilities
  8. Insurance and Financial Policies
  9. Uninsured Financial Policy
  10. Notice of Privacy Practices
  11. Colonoscopy Billing: What You Need to Know

If you are unable to print the forms, please arrive to the procedure center at least 20 minutes prior to your appointment and we will provide the forms to you.

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.

A Lady Cleaning the scopes
A boy and girl smiling picture
Prepping a Patient