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


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.

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 Program Medical Questionnaire
Download PDF

Open Access Patient Registration Form
Fill out form online

Colonoscopy Consent Form

Conscious Sedation Consent Form

Indigent Care Policy and Procedure

Acknowledgement of Receipt of Patients’ Rights and Advanced Directives