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Contact Us

Gastroenterology Associates, P.C.
2222 53rd Avenue
Bettendorf, Iowa 52722

Phone: 563-383-2686
Fax: 563-884-8144
E-mail  |  Map

Affiliated With Genesis Medical Center

Patient Forms

Patient Documents & Forms

  Your Information, Your Rights, Our Responsibilities ( PDF File )
  Patient Rights and Responsibilities Brochure ( PDF File )
  Acknowledgement of Reciept ( PDF File )
  Patient Information ( PDF File )
  Patient Medical History ( PDF File )
  Patient Authorization for Release of Information ( PDF File )

Patient Procedure Preparation Documents

  Flexible Sigmoidoscopy Preparation (With Sedation) ( PDF File )
  Flexible Sigmoidoscopy Preparation (Without Sedation) ( PDF File )
  GoLytely Split Preparation ( PDF File )
  HalfLytely Preparation ( PDF File )
  Miralax Preparation ( PDF File )
  Miralax Preparation with Mag Citrate ( PDF File )
  Movi Preparation ( PDF File )
  OsmoPrep Preparation ( PDF File )
  Prepopik Preparation ( PDF File )
  Suprep Preparation ( PDF File )
  Two Day Colon Preparation ( PDF File )

Breath Test Documents

  Fructose Breath Test Instructions ( PDF File )
  Glucose Breath Test Instructions (Diabetic) ( PDF File )
  Glucose Breath Test Instructions (Non-Diabetic) ( PDF File )
  Lactose Breath Test Instructions ( PDF File )