Patient Demographics

In consideration for services rendered by Gastroenterology Associates/Endoscopy Center of Ocala, I hereby agree to release the information requested, as needed, by my insurance company and assign insurance benefits to Gastroenterology Associates/Endoscopy Center of Ocala. I further agree to be solely responsible for any balances my insurance carrier does not pay.

It is your right to control access and disclosure of your health information. Please list the names of family members and/or friends with whom we may share your medical information and/or lab results. DUE TO PRIVACY LAWS, WE WILL NOT GIVE ANY INFORMATION TO ANYONE WHO IS NOT ON THIS LIST!

Please call our office if you have not been notified of a test result by 14 days of having the test performed.