2232 Wilborn Avenue
South Boston, VA 24592
     
    Southern Gastroenterology Associates     434.572.8196

Paperwork

Please fill out the necessary paperwork before your appointment. This will save time when you arrive at the office. The first form is a registration form verifying your personal information. The second form is the (HIPPA) Health Insurance Portability and Accountability Act. Another very important form is Health History. This is usually very detailed and will take some time to fill out. We also have a financial policy that you will need to review, sign and date. Please bring a photo i.d., your insurance and prescription drug cards along with all of your medications with dosages and any copays due.

If you have any questions while filling these forms out, please do not hesitate to call us. We’re here to make this process as easy as possible. You can also send us an email with your questions and concerns.

To make the process easier and quicker, please download, print and fill out these forms. You can bring them with you to your
appointment, or you can fax them to 434.572.8341.

Required Forms

PATIENT REGISTRATION
Make an appointment online Fill out our
form and a scheduling coordinator will
contact you to confirm your appointment.
FAX REFERRAL
NOTICE OF INFORMATION PRACTICES
INSTRUCTIONS FOR EGD
PERMISSION TO DISCUSS PHI
INSTRUCTIONS FOR FLEXIBLE SIGMOIDOSCOPY
INSTRUCTIONS FOR COLONOSCOPY (MIRALAX)
INSTRUCTIONS FOR COLONOSCOPY (MOVIPREP)
INSTRUCTIONS FOR COLONOSCOPY (TRILYTE)
INSTRUCTIONS FOR COLONOSCOPY (SUPREP)
SMALL BOWEL CAPSULE ENDOSCOPY

 


The Day of your Procedure

Remember you cannot eat or drink anything after midnight the night before your procedure. You may take your usual medications on the day of your exam unless otherwise instructed. Please take those medications with just enough water to swallow. You will not be able to drive home after your colonoscopy or EGD because of intravenous sedation. Please have a responsible adult available to take you home later that day. If any questions arise, please do not hesitate to contact us. Your safety is very important to us.

Post Care

You should not drive an automobile or use any equipment that may injure yourself or others 24 hours after discharge. Please have assistance when walking up or down stairs. To prevent nausea after you have been put to sleep, you should begin your food intake with liquids (any type of liquid – soup, broths, jello, ginger ale, etc.) and progress to solid foods slowly. You should not drink alcoholic beverages for 24 hours after discharge. If you become dizzy, lie down completely flat until all dizziness is gone. Legal decisions should be delayed for 24 hours after discharge. Parents may need assistance with children at home for the remainder of the day. If you have any problems after arriving home following your procedure, please contact us at 434-572-8196. If the office is closed, you can contact your doctor 24 hours a day by calling Halifax Regional Hospital at 434-572-8196.

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