If you have any questions regarding the Patient Forms feel free to contact our main office at 845-354-3700.
Patient
Registration Form
Consent
for Use and Disclosure of Protected Health Information
Patient
Financial Responsibility Statement
Card on File
Agreement
Notice of
Privacy Practices
HIPAA
Consent
Office Policies
Medical Procedure
Billing Form
Medical
Records Release Form
Patient
History Form
Medical
History ROS
The first visit to our office is designed to make your experience as comfortable as possible and get you better acquainted with who we are and all that we offer. We welcome your questions and always strive to deliver the utmost in care.
Your doctor may ask you a series of questions about your medical history and current symptoms, upon which you’ll be given a physical exam. Possible recommendations for treatment will then be discussed.
Please read your prep instructions carefully, at least 1 week before your appointment. Some medications such as blood thinners, diabetes or weight loss medications will need to be stopped prior your procedure. Failure to stop these medications may result in cancellation of your procedure.
Our office participates in many insurance plans. If your insurance plan is not listed, please call your insurance company to confirm participation.
For additional information regarding out-of-network benefits, plan-specific
information, or other billing and insurance inquiries, the following contact
will gladly assist you.
The main number for billing inquiries for Allied Digestive Health is: (732)
702-1039
Allied Digestive Health has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.
Once you enter your email, you will receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You will receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Is there a cost associated with obtaining my medical records?
HealthMark Group fulfills all requests for personal copies at no charge. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.
About
Our GI Care
For Your Visit
Wantagh North
P: 516-785-6800
F: 516-785-2121
1488 Wantagh Avenue
Wantagh, NY 11793
Mon – Thurs: 8:30AM – 5:00PM
Fri: 8:30AM- 4:30PM
Sat & Sun: Closed
Pomona
P: 845-354-3700
974 Route 45,
Suite 2000
Pomona, NY 10970
Mon – Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
© All Rights Reserved
Please call our office to schedule an appointment:
Pomona: (845)354-3700
Please call our office to schedule an appointment:
Pomona: 845-354-3700
