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REGISTRATION


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REGISTRATION


SCROLL BELOW REGISTRATION TO ACCESS OUR PATIENT FORMS & OTHER MATERIALS THAT YOU MAY NEED. PLEASE READ THE FOLLOWING CAREFULLY BEFORE PROCEEDING TO YOUR REGISTRATION INPUT:

Please be sure to read our guidelines regarding high BMI and other surgical risk factors which may influence our ability to consider your surgical candidacy before registering. We also encourage our visitors to read our FAQs as well.

We do not accept record packages for review by email; please do not email any related documents to the CEC staff or our surgeons. Please follow the instructions you will receive after registering to ensure a timely review of your case file.

The registration form below is for new records review cases only. If you have registered previously but did not send your case and would like to do so now, please first check to see if we have your prior registration on file before registering again. Thank you.

Please do not register if you are an existing CEC patient (current or any year prior) or have (or plan to schedule) an in-office appointment. If you are an existing CEC patient (from any year) in need of assistance, please call us at 770-913-0001 and we'll be delighted to help you. If you were looking to book an in-office appointment (consult costs will apply), please note appointments are not made online and you should not register for the records review; instead, please call us at 770-913-0001 and our staff will be delighted to book you and review the dates available/costs of your visit/insurance aspects with you. Thank you.

How the registration process works: every registration is responded to by email (or postal mail if email - the preferred method - is not available) with an information packet containing next steps, instructions, and all the necessary details and requirements for the free records review. The email packet is usually sent within 24-48 hours after you've registered unless otherwise specifically noted. If you do not receive your e-packet, please check your spam file. If you receive an email from one of our surgeons but not your packet of instructions, that means the mail went to your blocked/spam file or was otherwise not delivered. Please check and notify us accordingly if you still did not receive it by sending a message to Heather@CenterForEndo.com.

Please understand that we cannot process case file reviews on an 'urgent' basis.
Please also note that incomplete registrations will significantly delay processing of your file. Please fill out all fields accordingly as applicable. Again, please remember to read read our guidelines regarding high BMI and other surgical risk factors which may influence our ability to consider your surgical candidacy before registering. We also encourage our visitors to read our FAQs as well. Many thanks!

We are glad you're here and look forward to hopefully being able to help!

Date of Birth *
Date of Birth
Phone Number *
Phone Number




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Patient Forms


Patient Forms


The free Adobe Acrobat Reader is required to access and print our forms. If you do not have it, get it for free here.

CEC POLICIES

Please click here to access our policies regarding the following:

CEC Cancellation/No Show Policy for Office Appointments
CEC Cancellation/No Show Policy for Surgery
CEC Pain Management Policy

CEC Notice of Privacy Practices
CEC Travel Policy for our International & Out-Of-Town Surgical Patients
CEC Policy on Social Media Interaction
CEC Policy Regarding Administrative Fees
CEC POLICY REGARDING OUR NEW CREDIT CARD ON FILE REQUIREMENT

CEC FORMS

if you are: a first-time PATIENT with an in-office appointment date ALREADY SCHEDULED and YOU have been asked to download the 'new appointment' forms, Click here

if you are: a registered, prospective NEW patient undergoing OUR free review & PHONE CONSULT (UNREGISTERED RECORDS WILL NOT BE ACCEPTED OR REVIEWED) and have been asked to download the 'free review' forms, click here NOTE: PLEASE DO NOT DOWNLOAD/SEND THESE FORMS WITHOUT REGISTERING FIRST; PLEASE FOLLOW THE INSTRUCTIONS IN YOUR INFORMATIONAL E-PACKET YOU RECEIVE AFTER REGISTERING. THANK YOU.

if you are: a post-operative patient and have been asked to download the 'CEC evaluation' form, click here

if you are: a post-surgical patient and have been asked to download the 'follow-up questionnaire' at least 6 months after the date of your surgery, click here

if you are: seeking a medical records release form to provide your doctor's office with in order to have them send us your records (sending of separate records must be approved by program director first), click here

if you are: a prior cec patient in need of additional copies of your records from us (two operative sets are provided TO YOU at POST-OP AT no cost) for another provider (charges will apply, see office policies above), click here

if you are: seeking a copy of our bowel prep instruction sheet (also provided at preop), click here

If you are: seeking a copy of our prohibited pre-surgical medication list (also provided in pre-surgical packet), click here

Si usted está: buscando una copia de nuestro documento de póliza de seguro en español, haga clic aquí