Patient Forms

Download these forms, print them out, fill them out and bring them with you to speed up your visit with us.

Office Visit Forms

New Patient Forms

Includes the EMR Patient Interview Form and the Patient Information Form

2017 EMR Patient Interview Form

Patient Information Form

Provides CGC with your personal and insurance information.

Financial Policy

Charleston Gastroenterology Center financial information.

Authorization to Release Records

Allows you to authorize the release of your records and/or obtain your medical records.

CGS and CEC HIPAA Privacy Policy

Describes how information about you may be used and disclosed and how you can get access to this information.

Endoscopy Center Forms

Patient Rights and Responsibilities

Your rights regarding your treatment at CGC.

Financial Information Form

Provides information so that you understand the financial aspects of your treatment.

Anesthesia Patient Letter

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