Download, print, and fill in the appropriate forms ahead of time to make your office appointment check-in process go more smoothly.
If you’re having difficulty finding a form specific to your doctor, you will first need to select your primary GI doctor by visiting our Find a Provider page and searching your USDH physician’s name. Once you have done so, please revisit this page to find the appropriate form.
If you find yourself with any questions or concerns, please contact your doctor’s office for details.
US Digestive Health Patient Forms
- Consent-Assignment of Benefits – Practice (90.8 K)
- COVID-19 Symptom Screening Form (62.7 K)
- Financial Policy – Office (110.7 K)
- No Surprise Billing (166.2 K)
- Notice of Non-discrimination (227.8 K)
- Notice of Privacy Practices October 2021 (196.6 K)
- U.S. Digestive Health and Affiliates – HIPAA Patient Privacy (208.9 K)
- USDH Authorization for Release of Medical Records 2021 (63.8 K)
Downloads for Lancaster
- RGI Historial Medico del Paciente (687.8 K)
- RGI Medical History Form (166.6 K)
- RGI Release of Info Form (66 K)
Endoscopy Center Forms
- Consent-Assignment of Benefits Anesthesia (90.9 K)
- Financial Policy – ASC (109.6 K)
- HIPAA Contact Information (89.5 K)
- Notice of Privacy Practices Acknowledgement (110.3 K)