Downloadable Forms

All of our downloadable forms are PDF’s and require Adobe Reader to view.

General information

• Patient’s Rights and Responsibilities (English)
• Patient’s Rights and Responsibilities (Spanish)
• Patient’s Rights and Responsibilities (Vietnamese)
• Patient’s Rights and Responsibilities (Russian)
• Patient’s Rights and Responsibilities (Punjabi)

• Privacy Practices (English)
• Privacy Practices (Spanish)
• Privacy Practices (Vietnamese)
• Privacy Practices (Punjabi)

• Notice of Nondiscrimination (English)
• Notice of Nondiscrimination (Spanish)
• Notice of Nondiscrimination (Russian)

• Financial Policy (English)
• Financial Policy (Spanish)
• Financial Policy (Vietnamese)
• Financial Policy (Russian)
• Financial Policy (Punjabi)

New Patient Information

• Patient Information Form
• Patient Medical Information
• Patient Care Agreement
• Patient Emergency Contact List
• Release Outside Facility Medical Information to Northwest Gastroenterology Form
• Release Northwest Gastroenterology Medical Information to Another Facility Form

Procedure Consent Forms

• Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (English)
• Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Spanish)
• Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Russian)
• Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Vietnamese)
• Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Punjabi)
• Capsule Endoscopy Consent
• Hemorrhoid Banding Consent

Procedure Preparation Instructions:

• Colonoscopy; see Colonoscopy Preparation
• Capsule Endoscopy Preparation Instructions
• NOTE: There is no special preparation needed for hemorrhoid banding

Remicade Forms

• Patient Welcome Letter Infusion Center
• Remicade Informed Consent
• Remicade Patient Financial Responsibility
• Remicade Post-Infusion Instructions

Entyvio Forms

• Patient Welcome Letter Infusion Center
• Entyvio Informed Consent
• Entyvio Patient Financial Responsibility
• Entyvio Post-Infusion Instructions

Injectafer Forms

• Patient Welcome Letter Infusion Center
• Injectafer Informed Consent
• Injectafer Patient Financial Responsibility
• Injectafer Post-Infusion Instructions