Patient Forms

At Phoenix Endoscopy, your time is as valuable to us as it is to you. Upon scheduling your surgery, a member of our staff will provide you with the required forms to fill out. We encourage you to take time to complete these before arriving on day of surgery, so that we may care for you promptly. If you happen to misplace any of the provided forms, duplicates are available for download and print below.

Colonoscopy General Prep Instructions

Moviprep Standard Dosing Protocol

Polyethylene Glycol Standard Dose Protocol

General Prep Instructions

Suprep Split Dosing Protocol

Polyethylene Glycol Split Dose Protocol

Moviprep Split Dosing Protocol

Halflytely Split Dose Protocol

What should I expect prior to my procedure?

• When scheduling your appointment, along with contact information, you will be asked for your insurance information and some basic medical information, including current medications that you are taking.
• Your prep instructions will be sent to you by email, or postal service, your preference.
• The necessary prescription for your colon cleansing will be sent electronically to the pharmacy of your choice.
• Your insurance benefits will be confirmed and you will be informed of your financial responsibility.
• An endoscopy nurse will call you to get you pre-admitted.
• You will be asked to pay your co-pay, co-insurance or deductible.
• You will be asked to review and make any corrections to your demographic information
• Please leave valuables and jewelry at home.
• Wear comfortable, loose fitting clothes.
• Plan to arrive at the center 30 -45 minutes prior to the procedure. You should expect a stay of two hours.
• If you’re younger than 18, you must have a parent or guardian accompany you to sign your paperwork. If you are an adult who is unable to sign the consent, you must have someone with you who is authorized to sign on your behalf.
• Bring the name and phone number of the person (must be 16 years or older with a valid driver’s license) who will be taking you home. You will not be permitted to drive or leave the center without an adult chaperone.