Patient Forms

Colonoscopy Patient Form

In an effort to ensure all patients over the age of 50 are getting the recommended screening colonoscopy, we at East Mississippi Endoscopic Center have set up a program that will make the scheduling of these procedures easy for you. We call this program “Open Access Screening Colonoscopy.”

The Open Access Screening Colonoscopy is for any patient, 50 years of age or older, who is asymptomatic and who has no significant health risks.

You may complete a simple patient questionnaire that can be faxed, mailed or brought to us. A nurse will call you to review the information. If we find you need a GI evaluation prior to the procedure, we will set the appointment. Otherwise, we will schedule the screening colonoscopy and provide the patient with all instruction.

You may request the physician you wish to perform the procedure or one will be assigned.

Our gastroenterologists are always glad to see patients in their clinics who have specific GI symptoms and require further and complete GI evaluation.

It’s as simple as that. Please don’t hesitate to schedule Open Access Screening Colonoscopy

General Patient Form

We have provided forms for those patients that are coming to our office for other reasons than colonoscopy and we encourage you to print this questionnaire, file it out and bring it with you.  This will save you time waiting and you can fill it out in the comfort of your own home.