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Patient Forms

Patient History Forms

To expedite your visit, it is important that you fill out the Patient Registration Form, the Health History Bubble Sheet and bring your current health insurance cards. In addition please bring your co-pay and a referral from your primary medical doctor if applicable.

 

Connecticut GI Non-discrimination policy

Connecticut GI, PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.


Connecticut GI, PC provides free aids and services to people with disabilities to communicate effectively with us.


We provide qualified sign language interpreters and Free qualified language interpretation services to people whose primary language is not English.


Non-discrimination policy (PDF Download)

 

Medical Record Forms

New Federal Privacy rules (Health Insurance Portability and Accountability Act, also kown as HIPAA) are designed to give patients greater control over their medical records. The rules apply to hospitals, doctors, insurance and other organizations that transmit individually identifiable medical information electronically. CTGI, PC complies with these rules that are designed to preserve the privacy of identifiable patient information.

Colonoscopy and Endoscopy Forms

 


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