To expedite your visit please sign up for our patient portal and fill out your forms online! Or, if you prefer, you may print out your paperwork by clicking the links below. Don’t forget to bring your insurance card and any co-payment and primary care referral if applicable.
- Patient Acknowledgement and Consent Form
- Patient Registration Form
- Medical History Form
- Privacy Notice
- 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
Colonoscopy and Endoscopy Forms
- Advanced Directives
- Procedural Consent Form
- Patient Rights & Responsibilities
- Colonoscopy Insurance FAQS
Patient Assistance Forms
If your provider has encouraged you to enroll in a patient assistance program for your biologic therapy the links are below. Please select the appropriate link and you will be redirected to the pharmaceutical company’s website. Please contact our office if you have any questions.
- https://remicade.JanssenCarePathSavings.com
- https://www.entyviohcp.com/access-support
- https://www.humira.com/humira-complete/sign-up/savings-card
- https://stelara.janssencarepathsavings.com/#/app/home
- https://www.cimzia.com/cimplicity-program
Entyvio Connect and Janssen Care Path Savings Programs for Remicade and Stelara are also available in PDF forms. Print the appropriate pre-populated form below. Completed forms may be faxed directly to the patient assistance program (fax number located on form), Faxed or mailed to our corporate headquarters (address and fax number pre-populated on form), or brought with you to your next visit.
