Request an Appointment
Patient forms
At Gastrointestinal Specialists your time is as valuable to us as it is to you. That’s why we provide online access to a variety of forms that patients may complete before their visit. The following documents will help us expedite the check-in process for your appointment. Please take a moment to download and print the appropriate form(s).
Medical Records Release
If you would like to obtain a copy of your medical records please print and complete the form below. You can mail, fax or drop off your completed form to the office location where you receive treatment. All of our office locations (address/phone/fax) are listed on the medical release form for your convenience.
DOWNLOADPatient History
DOWNLOADPatient Information
DOWNLOADEndoscopy Center Forms
Prep Instructions
You’ll need to follow specific instructions to prepare for your colonoscopy exam. The reason is that in order for your doctor to be able to detect any issues during the colonoscopy, you first need to clean out your bowel. This includes adjusting your diet in the days leading up to the exam and taking the laxative preparation prescribed by your doctor at specific time intervals. Depending on the medication prescribed, you will need to follow slightly different steps.
Colon Preparation
Please discontinue the use of aspirin products, arthritis medication and iron tablets for one week before the examination. Tylenol may be used. For the best possible examination, the colon must be completely empty of waste material, so it is important that you follow the circled instructions set out below very carefully.
Endoscopy Preparation
For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, and oral medications after midnight the night before the exam, unless otherwise directed by your physician.
Do not take any aspirin or arthritis medications for seven days prior to the examination.
Prep for Upper Endoscopy:
The procedure you are going to have requires that you have nothing to eat or drink after midnight on the night before your examination. It is extremely important that you follow these instructions. Food or liquid in the stomach during the procedure could be dangerous. If you were to vomit you could possibly aspirate the liquids into your lungs. If you forget and eat or drink something please tell the nurse so that she may reschedule your procedure.
If you are on medication for high blood pressure or a heart condition please take your medication on the day of the procedure. Try to take your medications 2 hours before your scheduled time. Drink just enough water to swallow the pills.
If you are going to be sedated you must have someone to drive you home. You will not be able to use public transportation. Your family or friends may bring you to the office and leave. They may leave a number or we can call when you are ready to go home. Your visit will be as long as 2 to 3 hours for your examination.
Prep for Upper Endoscopy/Afternoon Procedure:
For patients with an afternoon appointment, you may continue to consume clear liquids up to 4 hours prior to your procedure arrival time. DO NOT EAT OR DRINK ANYTHING 4 HOURS BEFORE YOUR PROCEDURE.
If you are on medications for high blood pressure or heart disease please take your medication on the day of the procedure. If you normally take these medications in the morning please take them at your regular time.
You are going to be sedated and you must have someone to drive you home. You will not be able to use public transportation. Your family and friends may bring you to the office and leave. They may leave a number where we can call when you are ready to go home. Your visit will take as long as 2 to 3 hours for your exam.
Colonoscopy Pre Procedure Instructions
Please follow the instructions below prior to your colonoscopy. Also be sure to follow the instructions for your specific bowel preparation prescribed by your physician.
Special Instructions if you take Diabetes or Blood Thinning Medications:
Please contact the provider who manages these before your procedure and ask them whether you should stop taking them before the procedure and for how long prior.
Eating and Drinking Instructions for ALL bowel preparations:
2 Days Before Your Procedure:
- Do not eat foods high in Fiber. Examples are whole grain breads and cereals, fruits, nuts, seeds, quinoa, popcorn, and vegetables (cooked or raw)
1 Day Before Your Procedure:
- Do not eat solid foods
- Drink only “clear” liquids. These include water, clear fat-free broth, gelatin, clear fruit juice such as apple or white grape. You may have ice pops, carbonated beverages, sports drinks, tea, and coffee (you may add sugar)
- Do not eat or drink dairy products
Day of your Procedure:
- Do not eat solid foods.
- Stop drinking clear liquids at least 2 hours before your scheduled arrival time
- If you are vaccinated against COVID-19, you must bring your vaccine card (or a copy of both sides) to your appointment or your appointment may be rescheduled and a $200 cancelation fee may be applied to your account.
Medication Instructions:
- If you take daily medication, you may take this with sips of water before your scheduled arrival time.
- If you have diabetes or take blood thinners, follow instructions by the health care provider who manages those medications.
If you have additional questions, please review our Frequently Asked Questions.
Sutab
- The prescription for your preparation will be sent to your pharmacy one week prior to your procedure.
The directions on the Sutab box may differ from the directions below. Follow these instructions.
- Evening before your procedure (Start at 5pm)
-
-
Open the 1st bottle of tablets (12 count)
- Fill the provided container with 16-oz of water.
- Swallow 1 tablet every 1-2 minutes, flush with water. You should finish all 12 tablets and 16-oz of water within 30 minutes.
- You may consume additional water if needed.
- Do NOT break or crush the tablets.
-
Approximately 1 hour after taking the last tablet, fill the container with another 16-oz of water and drink over 30 minutes.
-
Approximately 30 minutes after finishing the second container of water, fill the container again with 16-oz of water and drink over 30 minutes.
-
Keep the container for the day of the procedure.
-
- Day of your procedure (Start at least 6 hours before you arrive to the office)
-
- Open the 2nd bottle of tablets (12 count)
-
-
- Fill the provided container with 16-oz of water.
- Swallow 1 tablet every 1-2 minutes, flush with water. You should finish all 12 tablets and 16-oz of water within 30 minutes.
- You may consume additional water if needed.
- Do NOT break or crush the tablets.
- You MUST complete consumption of all Sutab tablets and water at least 3-4 hours prior to your procedure.
- Two hours before you arrive to the office, stop drinking clear liquids.
-
Your physician may send your prescription for Sutab to Gifthealth Partners (staff will confirm with you).
Suprep
The prescription for your preparation will be sent to your pharmacy one week prior to your procedure.
The instructions on the Suprep box may differ from the directions in this section. Follow these instructions.
- Evening before your procedure (Start at 6pm)
-
-
Pour one bottle of solution into the mixing container.
-
Add cold water to the 16-oz line on the container and mix. Do NOT drink suprep without adding water.
-
Drink all of the solution in the container.
-
Over the next hour, drink two 16-oz containers (or more) of water. This is important to help cleanse your colon and keep you hydrated.
-
- Day of your procedure (Start at least 3 hours before you arrive to the office)
-
-
Pour the second bottle of Suprep into the mixing container.
-
Add cold water to the 16-oz line on the container.
-
Drink all of the solution in the container.
-
Drink two 16-oz containers of water.
-
- Two hours before you arrive to the office, stop drinking clear liquids.
Clenpiq
The prescription for your preparation will be sent to your pharmacy one week prior to your procedure.
The directions on the Clenpiq box may differ from the directions in this section. Follow these instructions.
- Evening before your procedure (Start at 6pm)
-
-
Drink 1 bottle of Clenpiq.
-
Over the next five hours, drink at least five 8-oz cups of clear liquid or water.
-
- Day of your procedure (Start at least 4 hours before you arrive to the office)
-
-
Drink the second Clenpiq bottle, then drink at least four 8-oz cups of clear liquid or water.
-
- Three hours before you arrive to the office, stop drinking clear liquids.
Golytely
Golytely, PEG-3350, TriLyte, Nulytely, Golyte-C
The prescription for your preparation will be sent to your pharmacy one week prior to your procedure.
Please note the directions on the prep box may differ from the directions on this page. Follow these instructions
- Prepare the Solution
-
-
Dissolve the powder in water before drinking
-
Fill the jug half way with lukewarm water. Warm water dissolves the powder better than cold water.
-
Shake the jug well to dissolve the powder.
-
Add cold water to the fill line on the jug. Again shake the jug well. The full jug contains sixteen 8-oz cups.
-
You may refrigerate the jug until you drink all of the solution.
-
Drink all of the solution within 24 hours after mixing it.
-
- Evening before your procedure (Start at 6pm)
-
Shake the jug of mixed solution well.
-
Drink one 8-oz cup of solution quickly. The solution will not work well if sipped slowly.
-
Every 10-15 minutes, quickly drink another cup of solution.
-
Continue to drink until 12 cups, or ¾ of the solution is drank. This may take up to 3 hours.
-
Keep the remainder of the solution to drink the day of your procedure. You may refrigerate the solution.
- Day of your procedure (Start at least 3 hours before you arrive to the office)
-
-
Shake the jug of mixed solution well.
-
Quickly drink one 8-oz cup of solution.
-
Every 10-15 minutes, quickly drink another cup of solution until you have drank all of the solution.
-
- Two hours before you arrive to the office, stop drinking clear liquids
Cancellations:
If you need to cancel your procedure, please call at least 48 hours prior to your scheduled procedure time. Failure to call 48 hours prior to your scheduled procedure will result in a $200 cancellation fee.