Forms

If possible, before your first colonic appointment, print out the below questionnaire and consent form provided as a portable document format (PDF) file.

To open the PDF you will need the free Adobe Reader program.
If you need that, first click this Get Adobe Reader link.

Questionnaire And Consent Form

Please bring the completed form to your first appointment.

Otherwise, if you are not able to print out and complete the form at home, please allow an extra 10 minutes before your appointment to complete the form at our office.