General Patient Forms can be found below.
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 provider’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.
- Consent Assignment of Benefits – Anesthesia
- Consent Assignment of Benefits – Practice
- Financial Policy ASC
- HIPAA Contact Information
- Notice of Privacy Practices
- Notice of Privacy Practices Acknowledgement
- Financial Policy Office
- Notice of Non-discrimination with Tag Lines
- USDH Authorization for Release of Medical Records 2021
- USDH Disclosure Notice Regarding Patient Protections Against Surprise Billing