Registration Forms

[Logo: Health Services 2 → links to /]

Colon & Digestive Health Specialists Eastside Endoscopy Center

Pay Bill

Appointments

Patient Demographic and HIPAA Form

Patient Demographic and HIPAA

Authorization to Release Medical Information Form

Authorization to Release Medical Information

Preparation Instructions Forms

Clenpiq & Suprep prep Instructions (diabetics)_(Piedmont Rockdale)

Clenpiq & Suprep prep Instructions for diabetics

Clenpiq instructions

EGD prep Instructions

Miralax 2 DAYS BEFORE

Miralax Prep Instructions (diabetics)

Miralax Prep Instructions (diabetics)_(Piedmont Rockdale)

Miralax Prep Instructions (Piedmont Rockdale)

Miralax Prep Instructions

Plenvu Preparation Instructions

Sigmoidoscopy Prep Instructions

Suprep & Clenpiq prep Instructions (Piedmont Rockdale)

Suprep & Clenpiq prep Instructions

Suprep instructions

Sutab Instructions

Consent Forms

(FOR INFORMATION PURPOSES ONLY)

AYSA Assignment of Benefits

COLONOSCOPY Consent

Consent for ANESTHESIA

EGD Consent

FINANCIAL Information & Consent

PREGNANCY TESTING Refusal Consent

PRIVACY CONTACT Information

SIGMOIDOSCOPY Consent

Declaration of the Healthcare Practice Form

(FOR INFORMATION PURPOSES ONLY)

Patient Rights and Responsibilities and other info

NOTE: Each of the items above is a downloadable form/document (PDF download links on the live site). The archived markdown capture did not preserve the underlying PDF file URLs — they will need to be re-linked to the practice’s form PDFs during the rebuild.


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Contact Us Today

(770) 922-7000

Our location

Colon & Digestive Health Specialists, 1805 Honey Creek Commons, Ste B, Conyers GA 30013

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Timings

Monday – Friday : 7:30am – 4:00 pm | Saturday & Sunday – CLOSED

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