New Patient Info & Forms

For your convenience, you may complete new patient forms in advance. To access our patient forms, please log into our Patient Portalfill them out completely and bring them with you to your appointment.

If you are not able to complete the forms before your visit, please allow at least 30 minutes for completion in the office before you see the doctor.

Patient Portal

Our online Patient Portal allows you to communicate with us easily and securely on your schedule. You can log into the online patient portal 24 hours a day, 7 days a week from the comfort and privacy of your home or office. Our patient portal allows you to:

  • View and request appointments
  • Request prescriptions and refills
  • Retrieve test results
  • View personal health information
  • Update demographic information
  • Browse health facts and information
  • View your billing statements and balance
  • Make secure credit card payments
  • Communicate with your doctor by sending and receiving secure messages

Try the Online Portal today!

Current Medications

Please bring all medications you are currently taking to your appointment.

Personal Identification Needed

Be sure to have your valid driver license and insurance card(s) with you.

Payment Policy

Due to recent changes in healthcare plans, some patients have questions regarding patient and insurance responsibility for services rendered. Our rates are representative of the usual and customary charges for our area. Please review our payment policy information below. You will be provided with a copy of this information to read and sign at your office visit. Please let us know if you have any questions or concerns.

Insurance

We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with, present your current card at your office visit so that we may verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.

Co-payments and deductibles

All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment and/or deductible at each visit.

Payments can be made in the form of cash, personal check or credit card. We accept MasterCard, Visa, Discover and American Express.

Coverage changes

If your insurance changes, please notify us before or on your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay within 30 days, you will be responsible for the balance.

Sleeve Gastrectomy Procedure

EC Sleeve Contract Updated

EC Sleeve Consent Updated

EC Sleeve Gastrectomy Patient Test

EC Bariatric Program Agreement

Gastric Bypass Procedure

EC Gastric Bypass Patient Test

EC Gastric Bypass Consent

EC Gastric Bypass Contract Updated

EC Bariatric Program Agreement

Laparoscopic Gastric Band Procedure

EC Laparoscopic Adjustable Gastric Band Consent

EC Laparoscopic Adjustable Gastric Band Contract

Gastric Band Removal Consent Form

EC Bariatric Program Agreement

Endoscopic Procedure

Endoscopic Sleeve Gastroplasty (ESG)

ESG Consent

EC Bariatric Program Agreement

Endoscopic Revision Procedure

Revision Consent

EC Bariatric Program Agreement

Hiatal Hernia Procedure

EC Hiatal Hernia