2630 Grant Line Road
New Albany, IN  47150

Phone:  812-945-0145
Fax:  812-949-5435

PATIENT INFORMATION

As a patient of Gastroenterology of Southern Indiana, we strive to make your time in our office as efficient as possible.  To help expedite your time, please complete the forms below and follow the instructions.

These documents are Adobe Acrobat files and work best in 9.0.  If you need to, you may download: 

Two easy steps:

1. PRINT this document [includes Financial Policy & HIPAA Authorization].  Sign in both places, then return to us prior to your office visit or procedure by:

• Faxing all to us at 812-949-5435 OR

• Bringing them to our office prior to your appointment

2. SAVE or PRINT this document [includes: Procedures Form, Patient Information, and Medical History] These documents are editable and you may choose to complete them on your computer.  Once they are completely filled out, return to us by:

• Printing and faxing all pages back to us at 812-949-5435 OR

• Email the completed form to Monica by clicking the "SUBMIT" button at the top of the form.  Then include your e-mail.

NOTE:  We need to have both these documents in order to get your procedure schedule with us.

If you would like to read our full HIPAA Policy, click on the link below.

HIPAA Policy

 

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Southern Indiana Endoscopy, LLC

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