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        Patient Forms

   

 

    We have two options for filling out our forms.

Option #1:
Click on the PDF Version below that can be downloaded to your computer and filled out then printed.
You can also print the PDF version and fill it out by hand.
To download the PDF version look for the download button typically located at the upper right hand corner of the screen depending on your browser. You will need the free Adobe Reader to fill it out on your computer and print the forms.

After completing the forms, you can:

Mail to:
Colon and Rectal Associates, LTD
1235 Old York Road,
Suite G 20
Abington, PA 19001

Please include copy of your driver's license, insurance card and COVID-19 vaccination card!

Fax to:
(215) 517-0821
Please include copy of your driver's license, insurance card and COVID-19 vaccination card!

Drop them off at our Office:
1235 Old York Road, Suite G 20, Abington, PA 19001
Please bring your driver's license, insurance card and COVID-19 vaccination card!



 Option #2:
Click on the Online version below that you can fill out and sign digitally online.
It will ask you for your name and E-mail to send you a email with a link to fill out the forms.
Please check your Junk Email Folder if you do not see it in your regular In Box!!
After completing the forms online, you will need to bring your driver license, insurance card and COVID-19 vaccination card to our office for your visit.

Please bring your driver's license, insurance card and COVID-19 vaccination card to your apointment.
     
Option #1:
PDF Versions are below
Option #2:
Online Versions are below
 
     
Open Access Packet Instructions Open Access Packet Instructions  
     
Office Visit Packet Abington Office Visit Packet Abington  
     
Office Visit Packet Holy Redeemer Office Visit Packet Holy Redeemer  
     
Office Visit Checklist - - -  
     
Prep Visit Packet Abington Prep Visit Packet Abington  
     
Prep Visit Packet Holy Redeemer Prep Visit Packet Holy Redeemer  
     
Office Prep Instructions - - -  
     
HIPAA Signature Form HIPAA Signature Form  
     
Billing Policy Form Billing Policy Form  
     
Notice of Privacy Practices (HIPAA) - - -  
     
COVID-19 Screening Form COVID-19 Screening Form  
     
     
         
     
     

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Colon And Rectal Associates, Ltd.,  All Rights Reserved.
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