Forms for Referring Physicians

Forms for Referring Physicians

Thank you for referring your patient to the Charleston Gastroenterology Clinic. We value our relationships with referring physicians and you may rest asured that they will receive the finest care at our facility.

In order to expedite the our processes, you may download any or all of several forms:

Appointment Request Form	For referring physicians only, this form enables you to schedule an appointment with CGC for your patient.

Patient Information Form	Provides CGC with your Patient's personal and insurance information.

Medical History Form	Enables us to understand your patient's medical status before providing further medical care.

HIPAA Consent Form	Provides your patient's authorizations and releases.

Financial Information Form	Provides information so that your patient understand the financial aspects of his or her treatment.

HIPAA Privacy Policy	Describes how information about your patient may be used and disclosed and how he or she can get access to this information.

Financial Policy	Charleston Gastroenterology Center financial information.

Patient Rights and Responsibilities	Your patient's rights regarding your treatment at CGC.

Anesthesia Patient Letter	Information for those who will receive anesthesia as part of their treatment.