Colonoscopy Request Form

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Name
Email
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Telephone
  
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Are you 50 or older?
Have you had a colonoscopy before?
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To help us coordinate your procedure, please list your primary care doctor (first and last name).
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Provide the city where your doctor's office is located.
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How would you prefer to be matched with a gastroenterologist?

Hendricks Regional Health operates a referral service that provides information from an updated list of physicians who are on our medical staff at the time of selection. The physicians pay no fee to be part of this service, and selection is based on your needs and preferences.