Patient Forms

Bring Patient Forms with you to your first visit

Thank you for selecting North Shore Gastroenterology in Westlake and Brooklyn, Ohio for your GI care. To schedule an appointment, please call us at (440) 808-1212 or use our online appointment request form.

Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.

Please be sure to bring forms with you to your first visit along with any diagnostic films or other test results that may have been ordered or performed by another physician.

Established patients can update forms online through our patient portal. If you need help accessing the portal, please call the office and we’ll be happy to help.

All new patients to North Shore Gastroenterology are required to complete the first three forms listed below. These documents are in PDF format.

Office Policy (complete this form prior to arrival)

Registration Form (complete this form prior to arrival)

Patient History Form (complete this form prior to arrival)

Endoscopy Consent Form

Authorization To Disclose Health Information To Another Provider

Authorization To Disclose Health Information Sent To North Shore Gastroenterology 

Advance Beneficiary Notice Form (only applies to Medicare patients)

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.