For your reference, our patient forms are located below. You will have an opportunity to review and approve these forms as part of Mobile Pre-Check or during the registration process once you arrive at Wichita Falls Endoscopy Center.
- Uninsured or Self Insured Good Faith Estimate
- Admission Acknowledgement
- Welcome Form
- Welcome Form - Spanish Version
- HIPAA Privacy Receipt Acknowledgement Form
- Notice of NonDiscrimination - Multi-Language
- Notice of Privacy Practices
- Notice of Privacy Practices - Spanish Version
- Patient Bill of Rights
- Patient Bill of Rights - Spanish Version
- Recent Travel Form
- TX Patient Notification of Data Collection
- TX Patient Notification of Data Collection - Spanish Version
In order to view or print these forms, you will need Adobe Acrobat Reader installed.
Click here to download it.
Insurance and Billing
Please contact our office to verify acceptance of your insurance plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure. We are happy to file insurance for your reimbursement as long as you are free to choose your own gastroenterologist.
Please see our Financial Coordinator for details.
What To Expect
Being well-prepared for your visit will ensure that the doctor has all of the needed information to provide the best possible care for you. It will also help alleviate any unnecessary anxiety you may be feeling prior to your first visit. Educate yourself on your symptoms by reviewing the content on this website. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.