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  • Referral Form

    SCHEDULING PHONE: (303) 788-8888
    FAX: (303) 790-2567 or (303) 788-6452

  • ***PLEASE ATTACH THE FORM BELOW SO AS NOT TO DELAY SCHEDULING OF PATIENT:

    1) PATIENT DEMOGRAPHIC AND INSURANCE SHEET

    2) MUST INCLUDE THE FOLLOWING RECORDS:
    CARDIAC, PULMONARY, RECENT H&P, OFFICE VISIT, RADIOLOGY, LABS AND PAST GI PROCEDURES

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  • We will be happy to schedule a Colonoscopy and/or EGD for reasonably healthy patients for the indications below. An office Consultation is strongly recommended for anything outside of these parameters.

  • EGD:

  • Colonoscopy: (ages up to 75)

  • Office Consultation Requested:

  • Should be Empty: