Patient Center

Patient Forms

Gastroenterolgy of Gwinnett

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.

1. Patient Registration Form
2. Financial Policy
3. Review of Systems
4. Medical Records Request
5. Medication List
6. Personal / Family History
7. 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.
8. HIPAA Notice of Privacy Practices
9. 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.

Northeast Endoscopy Center

• Advance Directives in English, Korean, & Spanish
• Patient Rights & Responsibilities in English, Korean, & Spanish

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