Your Visit

New Patient Forms

Thank you for choosing the Kendrick Colon & Rectal Center practice to provide your colon and rectal care. New patients must fill out a form so that we may start a file and keep them up-to-date. You will be given this form when you visit the office or you may download the new patient forms, complete it and bring it to your first appointment.

This notice of Privacy Practices describes how our office may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control of your protected health information. "Protected Health Information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You can obtain the revised notice by calling our office and requesting that a revised copy be sent to you in the mail or by downloading it. We ask that our patients read the Notice of Privacy Practices prior to your visit or you may read it in the office on your next visit.

We ask that our patients fill out, sign and return the Receipt of Privacy Notice Information, the HIPAA Permission to Disclose Information and the Procedural and Financial Consent forms. You may fill them out in the office on your next visit or you can download and complete these forms prior to your appointment.
 
Short-term disability or FMLA

Completion of short-term disability or FMLA (Family Medical Leave Act) forms could take 7 - 10 working days. Forms dropped off in the office at the Reception Desk will not be completed the same day. There is $25.00 charge per form, with payment due prior to the completion of the form(s).