Fill out our Direct Access Patient Referral Form below:

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Patient Information

Name*
Patient's Age Range*
Do you have a history of heart problems?*
Examples: Abnormal rythum (Afib, SVT), heart attack, coronary artery disease, cardiac stent placement, heart surgery, pacemaker
Do you have a history of lung problems?*
Examples: asthma, COPD, emphysema
Have you ever been diagnosed with a condition called sleep apnea?*
Do you have a history of neurological problems?*
Examples: stroke, seisure, fainting
Do you take any medications to thin your blood?*
Examples: Asprin, Eliquis, Xarelto, Plavix
Are you currently experiencing any GI issues?*
Examples: blood in stool, diarrhea, abdominal pain
Have your or anyone in your family been diagnosed with a condition called Malignant Hyperthermia after recieving anesthesia?*

Referring Doctor Information

If you have any questions, please contact us at (706) 613-1625.

How can we help you?

Discover the services we provide
Learn about the procedures we perform
Request an appointment
Find patient forms and preparation info
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Our Affiliates

Accreditation Association for Ambulatory Health Care
American College of Gastroenterology
American Society for Gastrointestinal Endoscopy
The Society of Gastroenterology Nurses and Associates