Get Tx Center For Digestive Health Pre-colonoscopy Patient Questionnaire 2018-2025

Completing the TX Center For Digestive Health Pre-colonoscopy Patient Questionnaire online is a critical step in preparing for your colonoscopy procedure. It is essential to provide accurate and comprehensive information to ensure your safety and the effectiveness of the procedure.

Follow the steps to successfully complete the questionnaire online.

1. Press the ‘Get Form’ button to access the questionnaire and open it in your preferred editor.
2. Begin by filling out the patient demographic information section. Provide your full name, social security number, date of birth, age, sex, address, city, zip code, race, ethnicity, preferred language, home phone number, cell phone number, email address, employer details, and emergency contact information.
3. Next, navigate to the insurance information section. If you do not have health insurance, check the provided box. Otherwise, fill in the insurance carrier name, member ID, address, group number, and contact details.
4. Proceed to the patient health information section. Record your height and weight, and respond to the general history questions by circling 'YES' or 'NO' and providing any necessary details in the spaces provided.
5. Continue with the previous history of colonoscopies and abdominal diseases section. Answer the questions truthfully, particularly regarding any past procedures and complications.
6. In the medications section, list all medications you have taken in the last two weeks, and specifically denote if you have taken any listed medications within the last week.
7. Complete the medical history questions, indicating any conditions you have experienced and surgeries you have undergone.
8. Review all your answers for accuracy. If uncertain about any particular answer, leave it blank or mark it with a question mark for clarification later.
9. Read the patient statement carefully. Sign and date the form in the designated spaces to confirm that you have provided truthful information.
10. Choose a preferred date for your colonoscopy and provide your contact preference. Lastly, attach a copy of your photo ID and insurance cards.
11. Once completed, mail the questionnaire in a stamped envelope to the specified address or you may choose to fax or email it as per the instructions provided.

Complete your questionnaire online today to ensure your colonoscopy preparation goes smoothly.