Open Access Colonoscopy

Open Access Colonoscopy is a service we provide that allows healthy, age-appropriate patients to easily schedule a colonoscopy, usually without a pre-procedure visit. .

Colonoscopy is advised for all average-risk patients, age 50 and older, as a method of colon cancer screening. Patients with significant illnesses (poorly controlled diabetes, significant cardiac disease, severe breathing problems, kidney problems) are advised to schedule a consultation prior to the procedure.

The physician will have very limited time to discuss past medical history or ongoing problems at the time of the Open Access procedure. If you have underlying abdominal pain, changes in bowel habits, or any other gastrointestinal issues, an Open Access Colonoscopy may not be the best initial examination for you. To ensure the highest quality care, we request individuals with these issues schedule a regular clinic visit prior to any procedure.

If you are in good health and wish to proceed to scheduling your procedure, please complete and submit the Open Access request form. Once submitted, you will receive and email within two to three business days by our staff to include information about the procedure and a link to complete a medical history.

A nurse will review your history then contact you to schedule the procedure and send you the proper bowel preparation instructions.

Open Access Colonoscopy

By completing this Open Access request form, your information will be sent to Northwest Hills Surgical Hospital. This form should never be used for medical emergencies or time-sensitive issues.

Appointment Request Form

Fill out the information below to request an appointment. Fields marked with an asterisk (*) are required.

*First, Last Name

DOB:

*Email Address

*Phone

Address


Street


City


State


Zip

Are you a new patient?

Will you be using insurance?

Preferred day

Preferred Physician

Patient Statement for Open Access Colonoscopy:


• Open Access Colonoscopy is designed to allow healthy, age appropriate patients to have a screening colonoscopy without an office visit. For my safety, depending on the answers provided, I understand I may be scheduled directly for a Screening Colonoscopy or if I do not meet open access criteria, an office visit will be scheduled.

• I understand that by choosing to pursue Open Access Colonoscopy, I have not, nor during this process will I have, a GI consultation. I understand that I have the choice to make an appointment for an office visit to discuss colonoscopy and have declined to do so. I also understand that I will require a separate office visit to address any GI complaints I might have.

• If I am scheduled directly for a Screening Colonoscopy I will be sent information by email regarding preparation for the procedure, the procedure itself, and post-procedure concerns. I will read the information provided and make sure that I understand and will be able to comply with the instructions given.

• I understand that, while not likely, there are risks involved with colonoscopy as with any medical procedure. These risks are outlined in the information that I will recieve. I will review this information to my complete satisfaction and I understand the risks and the benefits of colonoscopy.

• Should I have any changes in my health status or insurance after being scheduled, or any questions about the information I receive by email I will call the office at 512-346-1994.

• I understand that I must have someone drive me to the procedure and wait in the unit to drive me home. Without a driver in attendance the procedure will be cancelled.


*I UNDERSTAND I MAY BE ASKED TO SEE A NURSE OR PHYSICIAN BEFORE MY PROCEDURE IS SCHEDULED; SPECIFICALLY IF MY MEDICAL HISTORY PRECLUDES PARTICIPATION.

*I ACKNOWLEDGE THAT THIS FORM IS NOT SECURE. ANY HEALTH INFORMATION I CHOOSE TO SHARE ON THIS FORM IS AT MY OWN RISK.

*I AGREE TO THE TERMS OF SERVICE