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Patient Forms

If you have any questions regarding the Patient Forms feel free to contact our main office at 516-341-0990.

English

New Patient Packet (PDF)
Colon EGD Form (PDF)
Consent for Use and Disclosure of Protected Health Information (PHI) (PDF)
Medical Records Release (PDF)
Notice of Privacy Practices (PDF)
Office Policies (PDF)
Card on File Agreement (PDF)
Patient Financial Responsibility Statement (PDF)
Patient Registration Form (PDF)
Patient HIPAA Consent Form (PDF)
Medicare ABN
Medicaid ABN

Spanish

New Patient Packet (PDF)
Colon EGD Form (PDF)
Consent for Use and Disclosure of Protected Health Information (PHI) (PDF)
Medical Records Release (PDF)
Notice of Privacy Practices (PDF)
Office Policies (PDF)
Card on File Agreement (PDF)
Patient Financial Responsibility Statement (PDF)
Patient Registration Form (PDF)
Patient HIPAA Consent Form (PDF)

First Visit


Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.

Please Bring The Following Items With You To Your Visit

  • Most current insurance card(s)
  • Driver’s license or photo identification
  • Co-payment in the form of cash, check or credit card
  • A complete listing of your medication, including dosages
  • If you have seen a Gastroenterologist in the past and/or have had prior diagnostic testing done (CT scan, x-ray, lab work, etc.), please have those records forwarded to us in advance or bring with you to your appointment.
  • Ensure that our office has received a referral, if necessary, in advance of your appointment.

Insurance & Billing

Please contact our office to verify the acceptance of your insurance plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure and insurance plan. We are happy to file insurance for your reimbursement as long as you are free to choose your own gastroenterologist. For out-of-network services, the estimated amount a patient will be billed is available upon request.

The main number for billing inquiries for Allied Digestive Health is: 732-702-1039

View Our List Of Accepted Providers

  • Aetna
  • Amerihealth
  • ChampVA
  • Cigna
  • EA Health Charity Care
  • Emblem Health- GHI PPO
  • Empire Blue
  • First Health/Coventry
  • Geisinger
  • Horizon BCBS
  • Horizon Inner Circle Hackensack/Meridian
  • Magnacare
  • Medicare
  • Multiplan
  • Oxford
  • RR Medicare
  • Tricare- Humana
  • United Healthcare
  • VA Choice
  • VNA – RBG providers only
  • Wellcare- clinic providers only

FAQs

Parking is available under and adjacent to the building, in the marked spots for South Island Gastroenterology Associates. Additional parking is available across the street in the Gourmet Glatt parking lot.

Yes. Evening hours are available Monday through Thursday: Monday until 8:00 PM, Tuesday until 7:00 PM, Wednesday until 6:00 PM and Thursday until 7:00 PM. To book an evening appointment, call our office at 516-341-0990.

Appointment FAQs

We accept many insurance plans — see the full list under Insurance & Billing. Because qualifications for coverage may differ depending on the procedure and the plan, please call our office at 516-341-0990 to verify acceptance of your plan before your appointment.

Your first visit will be a consultation — see Patient Forms for what to bring and when to arrive. If you are scheduled for a procedure, review the Preparation Instructions tab for the prep specific to your procedure.

Prepare For Your Visit

Review Available Resources

Explore patient forms, preparation instructions for your upcoming procedure, FAQs, and insurance/billing information.

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