Patient Forms

Having your paperwork filled out before arriving for your treatment will save you time during your doctor's appointment.

Separate Patient Forms

Our patient forms are provided here in PDF format.

HIPAA Consent Form:

Requires your authorization to discuss any aspects of your health including office visit arrangement, diagnosis and plan of care.
Download - HIPPA Consent Form

Privacy and Financial Policy Form:

This form requires your acknowledgement of our privacy and financial policies.
Download - Privacy and Financial Policy Form

Medical and Family History Form:

This form is important to learn your medical history which is imperative to providing optimum care.
Download - Medical History Form

Medical Records Release Form:

Consent for Release of Health Information.

Download - Medical Records Release Form

Network Disclosure Statement:

Please return this form to Gastroenterology Specialist Of Delaware on or prior to your date of service.

Download - Network Disclosure Statement Form

New Patient Packets:

Select your New Patient Packets by whom you are assigned.
Dr. George Benes or Dr. Michael J. Brooks

Dr. George Benes:

Download - Dr. George Benes, New Patient Packet

Dr. Michael J. Brooks:

Download - Dr. Michael J. Brooks, New Patient Packet

Dr. Michael H. Bass:

Download - Dr. Michael H. Bass, New Patient Packet