Patient Forms


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What to expect when you check-in:

To protect you and your identity, our front office staff will ask for your photo identification (i.e. driver’s license, passport, military ID, etc.) and insurance cards for each visit. You will also be asked to have a photo taken for your medical record, if one is not already on file.

Patient identification and insurance verification is necessary to:

  • Ensure care is provided to the correct patient now and in the future
  • Protect against identity theft
  • Comply with state and federal laws and regulations that protect the security and integrity of patient information
  • Ensure proper billing of insurance on your behalf

You will also be asked to complete and/or update patient forms. This helps to ensure that we have accurate information and helps you to identify changes in your health history.

Patient Forms:

  1. Confidential Patient Information and General Consent for Treatment
  2. Medical History

Patient Notices:

  1. Notice of Privacy Practice & Authorization to Disclose Protected Health Information form
  2. Notice of Patient Rights and Responsibilities, including Notice of Ownership and Mission Statement (Note: Notice of Rights & Responsibilities will be provided verbally upon check-in)
  3. Notice of Advanced Directives Policy & Living Will resources in the State of Idaho
    Living will and Durable Power of Attorney for the State of Idaho
  4. Notice of Non-Discrimination & Accessibility
  5. Agreement of Financial Responsibility including Notice of Cancelation and No-Show Policy
  6. Colonoscopy – What You Need to Know!

Procedure Brochures:

Patient Instructions:

  1. Colonoscopy Procedures:
    1. Nulytely/Dulcolax Split Dose Preparation Instructions
    2. Miralax/Dulcolax Split Dose Preparation Instructions
    3. Suprep Split Dose Preparation Instructions
  2. Colonoscopy / Upper Endoscopy Combination Procedures:
    1. Nulytely/Dulcolax Split Dose Combo Preparation Instructions
    2. Miralax/Dulcolax Split Dose Combo Preparation Instructions
    3. Suprep Split Dose Combo Preparation Instructions
  3. Preparation Resources:
    1. Sample Clear Liquid Diet
    2. Low Fiber / Full Liquid / Clear Liquid Diet
    3. How to Tell if your Bowel is Clean Prior to Colonoscopy
    4. Frequently Asked Questions for Procedure Preparation