Appointments
Appointments

Forms and Preps - Washington

To Our Valued Patients

Thank you for being a patient of Gastro Health. Prior to your first appointment, please fill out these new patient forms and bring them with you to your first visit. 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) including Medicare and DSHS cards, 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

New Patient Form
 Patient Interview Form (To fill out your questionnaire, please log in to the patient portal and click on the questionnaire tab and submit each page.)

 

Additional Forms

Please find below additional forms from Gastro Health that you may need to reference throughout your care with us.

Notice of Privacy Practices
Authorization to Disclose PHI (Release of Information)
Advanced Directive Policy
Endoscopy Information Brochure
Procedure Billing: What You Need To Know

 

Procedure Preparation

Patients should read Prep FAQ’s and Instructions prior to a procedure. 

FAQ for Colonoscopy

    
FAQ for Endoscopy    
Pre-Procedure Diabetes or GLP-1 Medication Instructions - English Pre-Procedure Diabetes or GLP-1 Medication Instructions - Spanish
 Pre-Procedure Diabetes or GLP-1 Medication Instructions - Vietnamese 

 

Colonoscopy Prep Forms

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. 

Care Center Location Colonoscopy Prep Forms

Edmonds, Kirkland, Seattle - Fremont, Seattle - Northgate, Tri-Cities 
 Olympia

 

 

Other Procedure and Test Instructions

Care Center Location

Instructions
 Olympia

 

 

Safety

At Gastro Health Washington, we take the safety of our patients and staff seriously. Each of our site locations adheres to OSHA (Occupational Safety & Health Administration) Act standards and Washington state laws. Firearms, knives or weapons of any sort are not permitted on our premises. Smoking is not allowed within any of our buildings; a receptionist can direct you to a designated outdoor smoking area that is at least 25 feet from any windows or doorways. We also ask that during your visit you please refrain from cell phone use and put the ringer on silent or vibrate as a courtesy to others. We appreciate your cooperation and help to keep our practice a safe environment for all who visit.