Request an Appointment
ONLY SCREENING COLONOSCOPY PATIENTS CAN REQUEST AN APPOINTMENT ONLINE
We are an open-access clinic. If you are not experiencing GI symptoms, you do not need a referral from your doctor before requesting a screening appointment. If you have upper GI issues or symptoms, you need to go through your GI doctor for a referral first.
Please do not use this form if you need to reschedule a procedure. Instead, contact your physicians office. After you submit your request, our appointment scheduler will respond within 3 business days. See below for forms to complete. Established patients may log in to the patient portal to request appointments and update forms.
Patient Registration Forms
Evergreen Endoscopy Center in South Windsor, Connecticut welcomes you to our center. If you are a new patient, you may pre-register by downloading, printing, and completing the forms below. Please be sure to bring them with you to your appointment. Doing so will help speed up the new patient registration process.
Also, be sure to bring any diagnostic films or other test results that may have been ordered or performed by another physician.
- Confidential Channel Communication Request
- Acknowledgement of Receipt of Notice of Privacy Practices
- Summary of Privacy Practices
- Patient Bill of Rights
- Responsibilities of the Patient
- Colonoscopy Preparation for SUPREP
- Colonoscopy Preparation for PREPOPIK
- New Patient Registration
- Health History
Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.