Wale Ajumobi
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Forms

Established Patient Package

New Patient Package for PPO and other Insurance

New Patient Medicare Package

Detailed Description of Our Privacy Practice

Acknowledgement of Receipt of Privacy Practice

Records Release

 

Prep and Consent Forms

Consent and Prep for Capsule Endoscopy

Colonoscopy Consent

Medicare ABN for Colonoscopy

Consent and Prep for ERCP

Consent and Prep for EGD/a>

Dual Procedure Consent Form

FMT Consents

Prep for Ultrasound

For an Appointment:

please contact the office at:

Eisenhower Gastroenterology Specialty Clinic
39700 Bob Hope Drive, Suite 101, Rancho Mirage, CA, 92270
Phone: 760-773-2882
Fax: 760-773-2680

Copyright © 2014-2018 Adewale Ajumobi, MD, MBA, FACP