Gastro Health Ohio - Forms and Preps

New Patients

Thank you for becoming a patient of Gastro Health. Please arrive 30 minutes prior to your scheduled time to ensure all paperwork is complete before your appointment. Additionally, please bring with you a copy of your photo ID, insurance card(s), a referral issued by your primary care physician (if required by your insurance), a list of medications you’re taking, and any test or medical results that pertain to your visit. We look forward to seeing you!

New Patient Forms

Please choose the correct form based on the care center you go to. If you have any questions, call your Gastro Health care center.

Greater Cincinnati Area	Informational Letter Registration Form History and Physical Form HIPAA Form Notice of Privacy Practices
Lima and Surrounding Areas	New Patient Packet Notice of Privacy Practices
Springfield	Patient Information Form - English Patient Information Form - Creole History and Physical Form - English History and Physical Form - Creole HIPAA Form Notice of Privacy Practices

Additional Forms

Greater Cincinnati Area	Medical Release Forms
Lima and Surrounding Areas	Colorectal Cancer Screening Clinic Form Recall Procedure Form
Springfield	Financial Policy No Show Policy Physician Referral Form

Colonoscopy Prep Instructions

Please choose the correct prep based on the care center you go to and the prep brand you were instructed to use. If you have any questions, please reference the endoscopy center webpage where you are having your procedure at or call your Gastro Health care center.

Greater Cincinnati Area and Springfield	Any Prep Lytely/Peg 3350 Plenvu Suflave Suprep Sutab
Lima and Surrounding Areas	Getting Ready For Your Colonoscopy Plenvu Pre Senokot - Magnesium Citrate Prep Senokot - Miralax Prep Suprep Prep Sutab (The Endoscopy Center) Sutab (Hospital)

Other Procedure and Test Instructions

Greater Cincinnati Area	EGD Prep Flexible Sigmoidoscopy Prep
Lima and Surrounding Areas	EGD Prep Fructose Intolerance Test Lactose Intolerance Test Small Bowel Bacterial Overgrowth Test
Springfield	Anorectal Manometry Clear Liquid Diet High Fiber Diet Small Bowel Capsule Endoscopy Upper GI Endoscopy — English Upper GI Endoscopy — Creole Upper GI Endoscopy — Spanish

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Forms and Preps - Ohio

New Patients

New Patient Forms

Additional Forms

Colonoscopy Prep Instructions

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