Patient Forms
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*IMPORTANT UPDATE*
Important Insurance Update for Screening Colonoscopies
Gateway Endoscopy Center (GEC) Forms
- Colonoscopy – Standard
- Colonoscopy – Miralax
- Colonoscopy – Magnesium Citrate
- Upper Endoscopy
- Flexible Sigmoidoscopy
St. Luke’s Outpatient Center
- Colonoscopy – Standard
- Colonoscopy – Miralax
- Colonoscopy – Magnesium Citrate
- Upper Endoscopy
- Flexible Sigmoidoscopy
St. Louis Women’s Center
St. John’s Mercy Medical Center Forms
- Colonoscopy – Standard
- Colonoscopy – Miralax
- Colonoscopy – Magnesium Citrate
- Upper Endoscopy
- Flexible Sigmoidoscopy
Other Forms
- New Office Patient Form
- ERCP
- Lactose/Fructose Breath Testing
- Bacterial Overgrowth Testing
- Capsule Endoscopy
- Records Release
IMPORTANT NOTE: If you will be undergoing a “screening colonoscopy”, meaning that you presently don’t have any GI symptoms, please be aware that it during the procedure a polyp is removed or a biopsy is performed, some insurance carriers will no longer consider this a screening procedure and may charge you a higher rate. We recommend that you check with your insurance company prior to undergoing the procedure to determine if your benefits change based on whether a polypectomy or biopsy is performed during the colonoscopy!