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)
- 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