Patient-Forms---Info
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Patient Forms and Information
Your First Appointment
Insurance & Payment Info
Privacy Practices
Hospitals
New Patient Forms
Other Forms
•Patient Registration Form -(English) (Spanish

•Annual Update Form -(English) (Spanish)

•Medication List -(English) (Spanish)

•Financial Policy -(English) (Spanish)

•No Show/Cx Policy -(English) (Spanish)

•Consent to Disclose Information -(English) (Spanish)
•Notice of Privacy Practices -(English) (Spanish)

•Request to Release Information Form -(English) (Spanish)

•Request to Obtain Information Form -(English) (Spanish)

•Employee Recognition Ballot -(English) (Spanish)

​•Colonoscopy-What you need to know -(English) (Spanish)

​•Notice of Non-Discrimination & Accessibility-(English) (Spanish)
Gastroenterology Associates of S.W. Florida participates in Medicare and most major insurance plans. Our practice will file insurance claims on behalf of our patients; however, patients are responsible for deductibles, co-Insurance, co-payments and non-covered charges. If you have questions regarding billing or which insurance plans we currently participate in, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company. 
Please arrive 15-30 minutes early so that we can complete your initial paperwork. Also, please bring the following: 

•Patient's insurance card 
•Patient's Photo ID 
•List of current prescriptions and/or over-the-counter medication, including dose and frequency 
•Information about patient's medical & surgical history 
•Recent test results, x-rays, or relevant records 

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

Click To View our Privacy Practice
Click To Request to Restrict Your Information
Click To Request to Correct or Amend Your Information
Our physicians are on staff at the following medical facilities: 
Gulf Coast Medical Center 
Cape Coral Hospital


We do not attend or admit patients at the following medical facilities; Only Consulting Privileges at:
Lee Memorial Cleveland Campus
​•Health Park Medical Center
Gastroenterology Associates of S.W. Florida, P.A.
(239) 275-8882