Downloadable Forms
All of our downloadable forms are PDF’s and require Adobe Reader to view.
General information
- Patient’s Rights and Responsibilities (English)
- Patient’s Rights and Responsibilities (Spanish)
- Patient’s Rights and Responsibilities (Russian)
- Patient’s Rights and Responsibilities (Vietnamese)
- Patient’s Rights and Responsibilities (Punjabi)
- Privacy Practices (English)
- Privacy Practices (Spanish)
- Privacy Practices (Russian)
- Privacy Practices (Vietnamese)
- Privacy Practices (Punjabi)
- Notice of Nondiscrimination (English)
- Notice of Nondiscrimination (Spanish)
- Notice of Nondiscrimination (Russian)
New Patient Information
- Patient Demographics
- Patient Medical Information
- Text Messaging Policy
- Release Outside Facility Medical Information to Northwest Gastroenterology Form
- Release Northwest Gastroenterology Medical Information to Another Facility Form
- Acknowledgment of Notice of Privacy Practices (NW Gastroenterology)
- Acknowledgment of Notice of Privacy Practices (NW Endoscopy Center)
Procedure Consent Forms
- Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (English)
- Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Spanish)
- Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Russian)
- Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Vietnamese)
- Colonoscopy, Flexible Sigmoidoscopy, and Upper Endoscopy/EGD Consent (Punjabi)
- Capsule Endoscopy Consent
Anesthesia Consent Forms
- Anesthesia Consent (English)
- Anesthesia Consent (Spanish)
- Anesthesia Consent (Russian)
- Anesthesia Consent (Vietnamese)
- Anesthesia Consent (Punjabi)
Procedure Preparation Instructions
- Colonoscopy; see Colonoscopy Preparation
- Capsule Endoscopy Preparation Instructions
- NOTE: There is no special preparation needed for hemorrhoid banding
Infliximab (Remicade/Inflectra) Forms
- Patient Welcome Letter Infusion Center
- Infliximab (Remicade/Inflectra) Informed Consent
- Infliximab (Remicade/Inflectra) Patient Financial Responsibility
- Infliximab (Remicade/Inflectra) Post-Infusion Instructions
Vedolizumab (Entyvio) Forms
- Patient Welcome Letter Infusion Center
- Vedolizumab (Entyvio) Informed Consent
- Vedolizumab (Entyvio) Patient Financial Responsibility
- Vedolizumab (Entyvio) Post-Infusion Instructions
