Resources for Patients - Teaneck Gastroenterology Associates

Patient Forms

If you have any questions regarding the Patient Forms feel free to contact our main office at 201-837-9449.

Patient Registration Form
Consent for Use and Disclosure of Protected Health Information
Patient Financial Responsibility Statement
Card on File Agreement
Notice of Privacy Practices
HIPAA Consent
Office Policies
Medical Procedure Billing Form
Medical Records Release Form

FORMS

BILLING REFERENCE INFORMATION
DISCLOSURE FORM
ADVANCE DIRECTIVES DISCLOSURE
NEW JERSEY'S ADVANCE DIRECTIVE FORMS

First Visit

Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.

Please Bring The Following Items With You To Your Visit

Most current insurance card(s)
Driver’s license or photo identification
Co-payment in the form of cash, check or credit card
A complete listing of your medication, including dosages
If you have seen a Gastroenterologist in the past and/or have had prior diagnostic testing done CT scan, x-ray, lab work, etc.), please have those records forwarded to us in advance or bring with you to your appointment.
Ensure that our office has received a referral, if necessary, in advance of your appointment.

Preparation Instructions

Insurance & Billing

Please contact our office to verify the acceptance of your insurance plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure and insurance plan. We are happy to file insurance for your reimbursement as long as you are free to choose your own gastroenterologist. For out-of-network services, the estimated amount a patient will be billed is available upon request.

The main number for billing inquiries for Allied Digestive Health is: (732) 702-1039

View Our List Of Excepted Providers

Medicare
Horizon Blue Cross and Blue Shield
Aetna
Cigna
Empire Blue Cross Blue Shield
GHI
HIP
Magnacare
United Healthcare
Multiplan
Oscar
Meritain Health
US Healthcare
Emblem Health
and many others.

Prepare For Your Visit

Review Available Resources

Explore patient forms, preparation instructions for your upcoming procedure, FAQs, and insurance/billing information.

Book Appointment

Schedule Online

Whether you are a new or existing patient, you can make an appointment online in just a few steps.