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Forms

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Please Download the Forms Below

New Patient Demographic Forms
Procedure Financial Form
Consent for Endoscopy Procedure
Endoscopy Center Financial Agreement Form
Capsule Instructions
Capsule Consent
Release of Medical Records Form
HIPAA – Notice of Privacy Practices

PREP INSTRUCTIONS
EGD
FLEX SIG
MAG CITRATE PREP
MIRALAX PREP
MIRALAX-MYLICON PREP
MOVIPREP
NYLYTELY PREP
OSMO PREP
CLENPIQ SPLIT
SUPREP

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    Ever think about trying a different method of treatment for your current health status? Great Lakes Medical Research, LLC has multiple study opportunities that you may be interesting in joining!

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