*Required fields are marked with an asterisk.
Online Forms and Policies FAQ:
New Patient Form:
New Patient form for individuals to fill out who are new HIMG prior to
the first appointment.
Notice of Privacy Practice: Coming Soon!!
Privacy Practive Acknowldgement: Coming Soon!!
Medical Records Release:
Medical Records Release for patients to fill out and sign for release of
their individual medical records for other physicians and personal use.
Protected Health Information Release to Family Members:
Release for patients to sign for family members or designated individuals
to receive Protected Health Information (PHI) on in person, on the phone
Request for Confidential Communications
: Request for patient to receive alternate forms of communication from
HIMG for reasons of confidentiality.
Patient Satistaction Survey: Endoscopy: Patient satisfaction survey
for completion after a procedure in our GI/Endoscopy Suite. You will
receive an an e-mail or phone call requesting the completion of this survey. Coming Soon!!