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.
- Privacy Notice
- Patient Acknowledgement
- Patient Registration Form
- GI Health History Bubble Form * DO NOT PRINT IN COLOR – *requires #2 pencil to complete
- Financial Policy
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.
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.
Authorization for Release of Health Information
