Health History Questionnaire

You will be contacted via text message with a unique survey link. You must op-in (reply “yes”) to receive further text messages. If your physician’s office has provided us with your email address, you will also receive this link via email. This link is unique to you and for you to complete your medical history assessment. Please complete this as soon as possible, so that anesthesia may review your medical history and avoid delays or cancelations on the date of your procedure.

Schedule Appointment

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Direct Screen Colonoscopy Form

Name(Required)
Email(Required)
Contact Preference(Required)
By checking the box below, you certify that you understand that our facility’s website is not secured as we do not collect personal or private health information via our site. Accordingly, the “Contact Us” form is not intended for use with personal or private health information, however, e-mail sent via the “Contact Us” form is sent to a facility employee on a secure e-mail server. This form is for new patients inquiring about our facility and services. If you are a current patient, please call us at 903.437.6260.(Required)
By checking the box below, you certify that you understand that our facility’s website is not secured as we do not collect personal or private health information via our site. Accordingly, the “Contact Us” form is not intended for use with personal or private health information, however, e-mail sent via the “Contact Us” form is sent to a facility employee on a secure e-mail server. This form is for new patients inquiring about our facility and services. If you are a current patient, please call us at 903.437.6260.