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Intake Form


Upper Endoscopy Intake Form

Patients with significant illnesses—poorly controlled diabetes, significant cardiac disease, severe breathing problems, kidney problems—are required to schedule an office visit prior to the procedure and are not eligible for the Open-Access service. Also, if symptoms are present, such as underlying abdominal pain, changes in bowel habits, or any other gastrointestinal issues, an Open-Access Colonoscopy will not be the best initial procedure. In this case as well, a regular office visit should be scheduled. If you have any questions, please call our office at 505-999-1600.

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