IGC
Patient Forms
281-880-GUTS (4887)

The following forms are available for your education, review, and completion:

New Patient Forms

Patient History Form
Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy Practices
Authorization Form for Payment and Medical Treatment
Broken Appointment Policy
Authorization to Leave Personal Health Information by Alternate Means

Preps

HalfLytely Prep
TriLyte Prep
Fleet Phospho-soda Prep
Flexible Sigmoidoscopy Prep
Video Capsule Endoscopy Prep
Handouts

Dietary Aspects of Irritable Bowel Syndrome
Fiber Therapy in IBS

Fiber Sources in Common Foods

Nutritional Strategies for Managing Diarrhea

Controlling Intestinal Gas
Understanding Intestinal Gas

Dietary and Lifestyle Aspects of Reflux

Food-Symptom Journal