Easy Access Forms

At AG, we make it easy to fill out healthcare forms before you come in for a visit. You have the option to fill out forms online or download and print them. Any printed forms will need to be brought in to the Austin Gastroenterology office at the time of your visit.

Fill Out Forms Online

We use GMed to allow you to fill out forms online, pay bills or request appointments. To use this free, secure web service, you'll need to create an account and log in to our website.

Visit our secure forms page

Download Forms

We've included a list of forms for you to download, print and fill out. The forms you need will depend on whether you're a new or existing patient. If you're having a procedure done, you may need to download a prep form.

Unsure of which form you need? Contact your AG physician office for more information.

Prep and Endoscopy Center Forms

The following forms are intended for patients who have already scheduled an endoscopy center procedure. You should have received a copy of the applicable forms after scheduling your appointment. Please click a form, below, if you have lost or misplaced the original.

Acknowledgement Form

Prep Forms

New Patient Forms

Are you a new patient? Is this your first time visiting an AG office? Please fill out each of the following forms prior to your first appointment. If you choose to fill out these forms at our office, please arrive 20 minutes before your appointment.

Other Forms

These forms are often accessed by existing patients.

  • Authorization for Release of PHI (Patient Health Information)
    Please fill out this form if you are requesting a copy of your health records from AG.
  • Notice of Privacy Practices
    This informational document is referenced in the General Consent form.
  • Noticia de Practicas Privadas

  • English
    ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-696-6775 (TTY: 1-800-735-2989).

    ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-696-6775 (TTY: 1-800-735-2989).

    CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-877-696-6775 (TTY: 1-800-735-2989).

    注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-877-696-6775(TTY:1-800-735-2989).

    주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-877-696-6775 (TTY: 1-800-735-2989) 번으로 전화해 주십시오.

    ‎ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم رقم 6775-696-877-1-1
    (1-800-735-2989):والبكم الصم ھ

    ‎‎‎خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال ک 6775-696-877-1
    .(TTY: 1-800-735-2989)

    PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-877-696-6775 (TTY: 1-800-735-2989).

    ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-696-6775 (ATS: 1-800-735-2389).

    ध्यान द: यद आप हदी बोलते ह तो आपके िलए मुफ्त म भाषा सहायता सेवाएं उपलब्ध ह।1-877-696-6775 (TTY: 1-800-735-2989) पर कॉल कर।

    توجھ: اگر بھ زبان فارسی گفتگو می کنید، تسھیلات زبانی بصورت رایگان برای شما .بگیرید تماس 6775-696-877-1-1
    (TTY: 1-800-735-2389) با. باشد می فراھم

    ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-696-6775 (TTY: 1-800-735-2989).

    ચુ ના: જો તમેજરાતી બોલતા હો, તો િન:લ્કુ ભાષા સહાય સેવાઓ તમારા માટઉપલબ્ધ છ. ફોન કરો 1-877-696-6775 (TTY: 1-800-735-2989).

    ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-877-696-6775 (телетайп: 1-800-735-2989).

    注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-877-696-6775(TTY: 1-800-735-2989)まで、お電話にてご連絡ください。

    ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-877-696-6775 (TTY: 1-800-735-2989).

    Language Line
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