Paperwork to bring

Prior to your first visit to our clinic, we will mail you a personal history form to complete and bring with you to your appointment, or you may download the forms here.

We also ask that you bring, or have your referring physician send, any  medical records or test results related to your condition. In addition,  we will need the names and dosages of all medications you are currently  taking.

Office Visit Paperwork

Please print, fill out, and bring the following forms with you to your first office appointment:

The general patient paperwork documents include Patient Registration, Medical Records Release, Patient Interview, HIPAA, and Privacy Policy Forms.

General Paperwork Forms


Procedure Paperwork

If you have an appointment for a procedure, please see the paperwork below:

Procedure Information Packet -- Please read the Patient Instruction booklet very carefully. 

Open Access Welcome Letter -- For new patients having a procedure without a previous office visit.


Procedure Prep and Diet Instructions

To download procedure prep and diet instructions, please go to our Prep Center page.

Gastro One Administrative Office
2020 Exeter Road, Germantown, TN 38138
P: 901.682.1233 • F: 901.682.0044

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