Referral Form
SCHEDULING PHONE: (303) 788-8888FAX: (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
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.