Patient Forms

Patient forms are critical to ensure that CCDD and Huntsville Endoscopy Center has the most current information on our patients. By taking the time to supply us with this information, it will aid your physician in the accurate diagnosis and treatment of your ailments and speed along your visit.

Please print the appropriate forms below, fill them out, and bring them on the day of your appointment or procedure.
Please do not date or sign any form until the day of your visit.

Click the Necessary Forms Below: (Adobe Reader is required)

CCDD Office Visits

Patient Information form
(All New Patients)

Medical History form
(All New Patients)

Medication form
(All New Patients and with Each Visit)

Consent for Use and Disclosure of Healthcare Information
(All New Patients)

Huntsville Endoscopy Center Visits

Patient Information form
(Patients Having a Procedure)

Medical History form
(Patients Having a Procedure)

Valuables / Responsible Driver form
(Patients Having a Procedure)

This material does not cover all information and is not intended as a substitute for professional medical care. Some of this material may have been adapted from materials provided both online and in print by other reputable medical resources.