Initial Patient Visit Forms
Please complete and bring this with you on your first visit
COLONOSCOPY PREP – Miralax Preparation
Please read the entire packet NOW and again at least 1 week prior to your procedure.
COLONOSCOPY PREP – Halflytely Bowel Prep Kit
Please read the entire packet NOW and again at least 1 week prior to your procedure.
MOVIPREP
ADDITIONAL IMPORTANT INFORMATION
ALL NAIL POLISH MUST BE REMOVED PRIOR TO PROCEDURE.
If you have artificial nails of any type – they do not have to be removed, just the nail polish.
WOMEN OF CHILDBEARING YEARS – A pregnancy test may be required. If our anesthesiologist determines this test is necessary, you will be responsible for the cost of this procedure ($15.00)
IF YOU ARE TAKING COUMADIN, PLAVIX, EFFIENT, PRADAXA, OR XARELTO - You MUST stop this medication 5 days prior to your procedure. You MUST also get a letter from the doctor who prescribed it. Please ask the receptionist for a copy of the form which gives the needed criteria for this letter. WE WILL NOT Perform your procedure if you do not supply us with this authorization from your Cardiologist or Primary Care Physician.
