Colon & Rectal Surgery Associates, PC
1348 Walton Way Suite 6500
Augusta, GA 30901
p: 706.722.2118      f: 706.722.0342

Patient Portal

New Patient Forms

Yearly we ask you to update these forms so we have the most current information on you. Please bring a list of your medications, your insurance card, and a picture ID.

We also ask that you bring with you any test results that you have had recently or the physician notes if your physician sent you to see one of our physicians.

The forms can be printed off and completed then returned to us as soon as possible.

If you are new patient to us, please come at least 20 minutes early with your completed forms, insurance card and picture ID and give them to the receptionist when you sign in.

If you have a HMO insurance or a type of insurance that requires a referral, our office must have it before your appointment or we will have to reschedule your appointment.

All copays are due at check-in. There is a $5 charge if you do not pay it before your visit.

NEW PATIENT OFFICE PAPER WORK

Demographics and Financial Policy Demographics and Financial Policy

HIPAA Form HIPAA Form

Medical History Medical History

Notice of Privacy Notice of Privacy

PRIVATE INSURANCE COLONOSCOPY PAPERWORK

PRIVATE INSURANCE COLONOSCOPY PAPERWORK PRIVATE INSURANCE COLONOSCOPY PAPERWORK

Medicare Insurance Colonoscopy Paperwork

Medicare Insurance Colonoscopy Paperwork Medicare Insurance Colonoscopy Paperwork