Patient Forms

At Raleigh Endoscopy Center, your time is as valuable to us as it is to you. That’s why we provide online access to a variety of forms. Please take a moment to download and complete the patient information sheet. All other forms are for you to read only.

The Patient Health History Sheet should be completed in its entirety and submitted to the appropriate center two weeks prior to your appointment. Once you have completed the Patient Health History Sheet, please send utilizing one of the methods below:

Main: (919) 791-2061
North: (919) 256-7981
Cary: (919) 792-3061

Mail: 2417 Atrium Drive, Suite 101, NC 27607.

Please note if you have a Difficult Airway Letter from previous surgeries or use Home Oxygen, you may need to be rescheduled to the hospital for your procedure. Please notify your physician’s office if either of these situations pertain to you. If you are a smoker or chew tobacco, please refrain from smoking/chewing on the day of your procedure. If you have a question about the preparation for your procedure, please call your physician’s office.

Patient Health History
Patient Right's & Physician Notification of Ownership North
Patient Right's & Physician Notification of Ownership Cary
Patient Right's & Physician Notification of Ownership Main
Privacy Policy (English)
Privacy Policy (Spanish)
Discharge Instructions
Procedure Consent (English)
Procedure Consent (Spanish)
Anesthesia Consent (English)
Anesthesia Consent (Spanish)