• Please print out the Open Access Patient Registration/Qualification form. Fill out page 2 completely. Please fill in Referring Physician. This insures that your Primary Care Physician will receive your colonoscopy report. A referral from your Primary Care Physician (PCP) might be required for an Open Access Colonoscopy for medical insurance processing and approval. Please check with your medical benefits provider.  Please tell your medical provider that the Physician's Open Access forms are on our web-site.
• If you are being referring by your primary care physician. Your PCP will notify our Open Access Department that you have decided to have your procedure. Please fax to the Open Access department, The Open Access Patient Registration/Qualification form (see link below). 
•  After we receive your form, you will be contacted by our staff to schedule your procedure date or an office appointment (if you did not qualify for Open Access).

Forms required for Open Access Colonoscopy:

Open Access "Patient" Registration/Qualification Form (click here)- Please print out this form. Then complete page 2 and after completion, please fax to Open Access Department (704) 372-3605.

Open Access Forma Registro Calificacion de Paciente - Spanish (Espanol) version. Imprima Por favor este formulario. Entonces termine la pagina 2 y despues de terminacion, por favor envie la forma por fax al departamento Open Access al (704) 372-3605.