Appointments: 704.377.0246     General: 704.377.4009
Referring MDs Patient Portal 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.

Medical History Form
Patient Registration Form
Patient Satisfaction Survey (Endoscopy Division)
Patient Satisfaction Survey (Medical Group)
Patient Rights
Open Access Colonoscopy Program Medical Questionnaire
Colonoscopy Consent Form
Conscious Sedation Consent Form
Upper Endoscopy Consent Form
EGD Preparation Instructions
Indigent Care Policy and Procedure
Acknowledgement of Receipt of Patients' Rights and Advanced Directives
Colonoscopy Preparation Instructions