If you have any questions regarding the Patient Forms feel free to contact our main office at 732-349-4422.
Acknowledgment of Info Sheet
Authorization to Release Healthcare Information
Card on File Agreement
Consent for Use and Disclosure of Protected Health Information (PHI)
Facility Assignment of Benefits
In-Network Disclosure
Medical Records Release
Notice of Privacy Practices
Office Policies
Patient Demographics Sheet
Patient Financial Responsibility Statement
Patient Medication Sheet
Patient Rights Summary Sheet
Patient Registration Form
Patient HIPAA Consent Form
Anesthesia Information
Patient Information on Anesthesia Services
Sample Copy of Anesthesia Consent
Sample Copies of Informed Consents for Endoscopy Procedure and Anesthesia
Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.
Colonoscopy
General Colonoscopy Instructions
1A-Miralax Dulcolax Prep clear liq
1B-Miralax Dulcolax Split Prep clear liq
2A-Citrate Miralax Dulcolax clear liq
2B-Citrate miralax dulco Split 2021
3-Extended double Citrate miralax dulco Splitclear liq
4A-OSMO prepclear liq
4B-OSMO Split prep clear liq
5-2 DAYCitrate Miralax Dulcolax Prepclear liq
6-2 DAY miralax Dulcolax Prepclear liq
7A-Citrate Dulcolax 2021 clear liq
7B-Citrate Dulcolax split clear liq
8A-Citrate Miralax Prepclear liq
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Our Endoscopy Centers strive to give the best patient care possible, from start to finish. This includes having our patients informed so they do not incur unnecessary costs. We know how complex the healthcare system has become and would like to make things a little bit easier.
It is also important to contact your insurance company because there are so many different plans that have different levels of coverage. To find out what out-of-pocket costs you may be responsible for you should contact your specific plan. The facility might be in-network but there could be a deductible, co-payment, or co-insurance that you are not aware of.
Please check with your insurance company to see whether we are listed as a participating provider. For all billing questions please call our office.
Allied Digestive Health has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.
Once you enter your email, you will receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You will receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Is there a cost associated with obtaining my medical records?
HealthMark Group fulfills all requests for personal copies at no charge. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.
About
Our GI Care
For Your Visit
Toms River Office
(Main Office)
477 Lakehurst Road
Toms River, NJ 08755
P: 732-349-4422
Mon – Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
Toms River Office
473 Lakehurst Road
Toms River, NJ 08755
P: 732-349-4422
Mon – Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
Brick Office
1617 Route 88 West
Brick, NJ 08724
P: 732-349-4422
Mon – Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
Forked River Office
939 Lacey Road
Forked River, NJ 08731
P: 732-349-4422
Mon – Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
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