Colonoscopy Pre-Registration

Patients who want to self-refer for colon cancer screening via colonoscopy can pre-register online. You will be scheduled for a no-cost pre-colonoscopy interview with a nurse or medical assistant either in person or over the phone to review your medical history and discuss colonoscopy preparations.

Please note that the nurse/medical assistant may arrange for you to meet one of the Northwest Gastroenterology providers for an office visit prior to colonoscopy if the nurse/medical assistant determines that there are medical issues that should be discussed prior to colonoscopy.

This service is designed to make colon cancer screening as convenient as possible for healthy patients with no major gastrointestinal complaints. You may register via the form below.

If you have any questions regarding the process, contact our procedure scheduling department via option 2 at our main office number (360-734-1420) or via two direct scheduling numbers (360-543-5060 or 360-543-5055).

Please do not use this form to convey sensitive medical information.

Pre-Registration Form

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Name*

First Last

Date of Birth*

Street Address*

City*

State*

Zip*

Phone*

Primary Care Physician (If you have one)

Best time to reach you

Any additional information you would like to add

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