Charlotte Gastroenterology & Hepatology | Forms - Charlotte Gastroenterology & Hepatology

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.

Indigent Care Policy and Procedure

Acknowledgement of Receipt of Patients’ Rights and Advanced Directives

View or print PDF (CGH)
View or print PDF (Endoscopy Center of Lake Norman)

Colonoscopy Preparation Instructions

MIRALAX
NuLYTELY
NuLYTELY (Espanol)
MOVIPREP
SUPREP
SUTAB- English
SUTAB- Espanol

Medical Records Release Form

Authorization and Fee Guide for Release of Records
Authorization to Release Medical Information to CGH

Forms

Recall Medical History Form

Recall Patient Registration Form

Patient Satisfaction Survey (Endoscopy Division)

Patient Satisfaction Survey (Medical Group)

Patient Rights

Open Access Colonoscopy Program Medical Questionnaire

Open Access Patient Registration Form

Colonoscopy Consent Form

Conscious Sedation Consent Form

Upper Endoscopy

Colonoscopy Preparation Assistance

Indigent Care Policy and Procedure

Acknowledgement of Receipt of Patients’ Rights and Advanced Directives

Colonoscopy Preparation Instructions

Medical Records Release Form

GI Links

Additional Links

MyChart at Charlotte Gastro

MyChart Access

Notice of Privacy Rights