Patient Forms

Patient Forms

To expedite your first visit, please go to  ksgastro.mygportal.com  to complete the Patient Interview Form online. If you are unable to complete the forms online, you can print them below and bring them to your appointment.

• Patient Interview Form
• Patient Interview Form - Spanish
• Kansas Gastroenterology Clinic Financial Policy
• Kansas Endoscopy Procedure Financial Policy 
• Permission to Disclose
• Privacy Policy Notice 

If you would like to authorize the release of your medical information, please download, print and complete the following form:

• Medical Record Release

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Prep Instructions

For your convenience, our procedure preparation instructions are located below:

•  Colonoscopy Instructions 
•  EGD Instructions 
•  Miralax Instructions 
• SuPrep Instructions
• NuLytely GoLytely Gavilyte Prep Instructions
• PlenVu Instructions

In order to view or print these forms you will need Adobe Acrobat Reader installed.  Click here to download it.