Appointments: 704.377.0246     General: 704.377.4009
Referring MDs MyChart Online Payment Center

Forms

For your convenience, Charlotte Gastroenterology & Hepatology is pleased to provide patient forms online.

Patient Forms 

We know your time is important. Therefore, we have provided our most commonly used forms online to help expedite the check-in portion of your visit to our office.

Procedure forms

For the fastest service, please complete the online form. If you are unable to complete the online form, please complete the printable form. To return the printable form, you may fax it to 704-602-6578 or return to the closest CGH location.

complete the form online


Recall Medical History Form
Fill out form online
Recall Patient Registration Form
Fill out form online
Patient Satisfaction Survey (Endoscopy Division)
Patient Satisfaction Survey (Medical Group)
Patient Rights
            Notice of Good Faith Estimate
Open Access Colonoscopy Medical History Form
Download PDF
Open Access Patient Registration Form
Fill out form online
Colonoscopy Consent Form
Conscious Sedation Consent Form
Acknowledgement of Receipt of Patients’ Rights and Advanced Directives