Patient forms

To expedite your visit please sign up for our patient portal and fill out your forms online! Or, if you prefer, you may print out your paperwork by clicking the links below. Don’t forget to bring your insurance card and any co-payment and primary care referral if applicable.

Authorization for Release of Health Information

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Financial Policy

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Medical History Form

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Patient Acknowledgement and Consent Form

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Patient Registration Form

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Patient Treatment Policy

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Privacy Notice

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Medical Record Forms

Patient Instructions for Medical Record Requests
HealthMark Group is a trusted provider that helps practices like ours manage the release of medical records. We chose to partner with HealthMark to streamline the process and get you your records faster and more efficiently.

How do I request my medical records?
Submit Here
Once you enter your email, you’ll receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You’ll receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
 
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Any questions?
You can see the status of your request any time inside Request Manager. If you have any other questions, feel free to reach out to HealthMark at 800-659-4035 or status@healthmark-group.com .

Colonoscopy and Endoscopy Forms

Advanced Directives

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Colonoscopy Insurance FAQS

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Patient Rights & Responsibilities

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Procedural Consent Form

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Patient Assistance Forms

Entyvio Connect and Janssen Care Path Savings Programs for Remicade and Stelara are also available in PDF forms. Print the appropriate pre-populated form below. Completed forms may be faxed directly to the patient assistance program (fax number located on form), Faxed or mailed to our corporate headquarters (address and fax number pre-populated on form), or brought with you to your next visit.

 

Entyvio Connect Co-Pay Assistance Form

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Remicade-Janssen Care Path Savings Program

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Stelara-Janssen Care Path Savings Program

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Preparing for your Procedure

In this section you can find information regarding specific procedures, the preparations advised, and what to expect before and after the examination. If you have additional questions or concerns, please contact your physician. Please feel free to explore this section to learn about the range of examinations offered by Connecticut GI physicians.

24 HR Esophageal pH Monitoring

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Anorectal Manometry & Biofeedback

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Breath Testing

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Capsule Endoscopy

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Colonoscopy

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Colonoscopy Patient Instructions

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Endoscopic Ultrasound

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ERCP

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Flexible Sigmoidoscopy

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High Resolution Esophageal Manometry

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Liver Biopsy

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Radiofrequency Ablation/Barrx

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Temporary Gastric Pacemakers

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Upper Endoscopy

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