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American Society of Colon & Rectal Surgeons

Preparation For Your First Visit

  • Please have all insurance information available for our visit. A detailed medical history is required for all new patients.
  • You may eat and drink normally before your appointment.
  • Do not take any laxatives or purgatives by mouth.
  • Purchase two (2) saline Fleet Enemas (green and white box) from your local pharmacy or supermarket.
  • Two hours prior to your appointment time, administer the first enema according to the directions listed on the box.
  • One and one half (1 1/2) hours prior to your appointment time, administer the 2nd Fleet Enema.
  • DO NOT TAKE Enemas if Contraindicated on the Fleet Enema Box instructions.
  • You may complete our New Patient Forms in advance by downloading the documents below
    • Please print on white paper and bring completed forms to your appointment
EHR HIPPA Agreement  EHR HIPPA Agreement


EHR Insurance Agreement  EHR Insurance Agreement


EHR Patient Registration  EHR Patient Registration


History & Physical  History & Physical


Review of Systems  Review of Systems


Bowel Control Satisfaction Survey  Bowel Control Satisfaction Survey
 
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