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 (Russian)
• Privacy Practices (Punjabi)

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

New Patient Information

• Patient Information Form
• Patient Medical Information
• Patient Care/Financial 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

Infliximab (Remicade/Inflectra) Forms

• Patient Welcome Letter Infusion Center
• Infliximab (Remicade/Inflectra) Informed Consent
• Infliximab (Remicade/Inflectra) Patient Financial Responsibility
• Infliximab (Remicade/Inflectra) Post-Infusion Instructions

Vedolizumab (Entyvio) Forms

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

Injectafer Forms

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