Houston Gastroenterology Patient Forms

Bay Area Gastroenterology offers two convenient methods of completing the forms necessary for proper handling of patient records:

You can use our secure medical record portal/gPortal. If you have not registered for the gPortal please contact our office to receive an invite to your email with a 6 digit pin number to register.

or

You may download the forms in PDF format. If needed, download the free Adobe Acrobat Reader from Adobe to view and print the PDF versions of the form. Depending on the version of your web browser, the PDF files may open in your browser window. If this is the case, simply print the forms from your web browser. Fill them out and remember to bring them with you on your visit.

Online Version

Clinical Evaluation - New Patient Interview Form

PDF Version

Clinical Evaluation Form (New Patient Interview Form)
Patient Registration Form (Patient Demographics)

Patient Consent of Release of Information

HIPAA Form (Consent for Release of Information)
ERX Consent Form (ePrescribing Consent Form)
Receipt of Notice of Privacy Practices Form

Locations | Maps

Medical Center
1015 Medical Center Blvd. Suite 1700
Webster, Texas 77598
p: 281-480-6264
f: 281-480-4046

Methodist St. John
2060 Space Park Drive
Suite 200
Nassau Bay, TX 77058
p: 281-480-6264
f: 281-339-7623

Memorial Southeast
11920 Astoria Blvd.
Suite 410
Houston, TX 77089
p: 281-484-6264
f: 281-484-0740

Pearland
10905 Memorial Herman Drive
Suite 211
Pearland, Texas 77584
p: 281-480-6264
f: 281-480-4046

Local Communities Serving Bay Area Gastroenterology

Alvin, Bacliff, Bay Area, Channelview, Clear Lake, Deer Park, Dickinson, Friendswood, Galena Park, Galveston, Houston, Kemah, La Marque, La Porte, League City, Manuel, Missouri City, Nassau Bay, Pasadena, Pearland, Santa Fe, Seabrook, Shoreacres, South East Houston, South Shore, Texas City, Webster


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Accredited X-Ray Pathology Facility

CT Scans and Ultrasounds
Bay Area Gastroenterology is an accredited imaging facility providing on site CT scans and Ultrasound imaging

CERT Certification
Bay Area Gastroenterology provides College of American Pathologists certified pathology services

Members of ASGE

The physicians of Bay Area Gastroenterology are proud owners of an on site ASGE certified Endoscopy Center


Onsite infusion services provided for the treatment of Crohn's Disease and Ulcerative Colitis

Medical Research
Bay Area Gastroenterology is currently involved in several research projects including:
Crohn's Disease and Irritable Bowel Syndrome
Please contact Rick Rodriguez for more information, rrodriguez@gibay.com