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Ambulatory Surgery Center (ASC)

Procedure Prep Instructions & Forms

Select Your Procedure

Endoscopy

Endoscopy Instructions & Forms required for your procedure.
  1. Authorization and Informed Consent, receipt of “Information Brochure “About Your Outpatient visit” (Sign and Submit) Information Brochure “About Your Outpatient visit” link is on form.
  2. Anesthesia Consent (Sign and Submit)
  3. Billing Procedures for our ASC (Sign and Submit)
  4. HIPAA Consent Form (Sign and Submit)
  5. Advanced Directives (Sign and Submit)
  6. Medication Form (Print, fill out and bring with you on the day of your procedure)
  7. Medical and Surgical History (Print, fill out and bring with you on the day of your procedure)
  8. Discharge Instructions (Print, fill out and bring with you on the day of your procedure)
Colonoscopy

Colonoscopy Instructions & Forms required for your procedure.
  1. Authorization and Informed Consent, receipt of “Information Brochure “About Your Outpatient visit” (Sign and Submit) Information Brochure “About Your Outpatient visit” link is on form.
  2. Choose one of the appropriate procedure preps as directed by your physician Miralax Colonoscopy Prep Instructions or SUPREP Bowel Prep Kit (Print and Keep)
  3. Anesthesia Consent (Sign and Submit)
  4. Billing Procedures for our ASC (Sign and Submit)
  5. HIPPA Consent Form (Sign and Submit)
  6. Advanced Directives (Sign and Submit)
  7. Medication Form (Print, fill out and bring with you on the day of your procedure)
  8. Medical and Surgical History (Print, fill out and bring with you on the day of your procedure)
  9. Discharge Instructions (Print, fill out and bring with you on the day of your procedure)
Flexible Sigmoidoscopy