CCDD Patient Forms
Please Print and Return These Forms
Each patient form below provides your physician and our office staff with the information necessary to offer you the best possible diagnosis, treatment, care, and service. Having these forms completed prior to your arrival at Center for Colon & Digestive Disease (CCDD) will also help speed along your visit. Simply download, complete, print, and return these forms on or before your appointment date. NOTICE: these forms are for CCDD patients only. If you need forms for the Huntsville Endoscopy Center, please go here.
Frequently Asked Questions: Just Click a Topic.
Patient Forms for Completion:
- All Patient Forms - contains all 7 forms below.
- Patient Information
- Medical History
- Surgical History
- Medication List
(New Patients & Existing Patients with Each Visit)
- Consent for Use and Disclosure of Healthcare Information
- Medical Records Release
Can These Forms Be Submitted Online?
Specifically because we respect your private health information, these forms CANNOT BE SUBMITTED ONLINE. Please print each form and return them to our office.<to the top>
- YOU MUST HAVE A PRINTER, and
- a supported computer, laptop, tablet, or smartphone, and
- the free Adobe Acrobat Reader app (version 10 or above).
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Who Needs These Forms?
All patients of the Center for Colon & Digestive Disease should complete, print, and return the forms listed above as required. A description of who needs to complete each form is provided below the respective form name. If you need forms for the Huntsville Endoscopy Center instead, please go here.<to the top>
Which Forms Do I Need to Complete?
Patients visiting the Center for Colon & Digestive Disease for the first time should complete, print, and return all patient forms listed above. Existing CCDD patients should complete, print, and return the Medication List form with each office visit.<to the top>
Help Completing the Forms
The patient forms found here look exactly like the ones you receive in our office. The only difference is these forms provide you with the option of using a pen OR a computer keyboard to enter your information.
- You must have a printer regardless of how you complete the forms.
- Entering your information into the forms with a keyboard is ONLY SUPPORTED by the free Adobe Reader (Version 10 or higher please). The Adobe Reader is available for Windows (Microsoft) and Mac (Apple) computers, as well as Android, and iPhone/iPad (Apple) tablets and smartphones. While you may be able to display and print these forms using a variety of other apps, YOU WILL NOT BE ABLE TO FILL-IN THE FORMS WITHOUT THE ADOBE READER APP.
- For the sake of your privacy, these forms CANNOT be submitted online.
Completing the Forms with a Pen
Simply click or tap on the form you wish to fill-out. Be sure it opens inside the free Adobe Reader (Version 10 or higher please). Within the Adobe Reader you can print the form on your printer and then use a pen to fill-in the form. Don't forget to sign it, date it, and of course, bring it to our office on the day of your procedure.
Completing the Forms with a Computer Keyboard
Simply click or tap on the form you wish to fill-out. Be sure it opens inside the free Adobe Reader (Version 10 or higher please). Then, click/tap on the first form field. Enter the requested information (for instance your first name). Click/tap on bubbles and boxes to select options and click/tap inside text fields to type the requested information. When you've completed one form field, click/tap on the next form field. Most desktop and laptop computers will allow you to use the "Tab" keyboard button to "jump" to the next form field. When you have completed all necessary form fields, please print the form and make any necessary notations or corrections with a pen. Finally, please sign it, date it, and of course, bring it to our office the day of your procedure.<to the top>
To protect your privacy, our patient forms NEVER capture, submit, nor otherwise transmit your personal health information over the Internet. However, any information you supply and enter into one of our forms could be stored on YOUR computer, phone, tablet, or printer. If this concerns you, please consult those companies (e.g., Microsoft, Apple, Google, Firefox, Verizon, AT&T, Hewlett-Packard, etc.) to learn how to delete personal information that may potentially be stored/cached.