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• Direct Access Endoscopy

Memorial City Office -
915 Gessner, Suite 625
Houston, Texas 77024
Phone (713) 461-7091
Fax (713) 461-1042

Katy Office -
701 S. Fry Rd., Suite 220
Katy, Texas 77450
Phone (281) 647-6667
Fax (281) 647-6610

Candidates for Direct Access Endoscopy

Please follow these 3 simple steps:

• Step 1
• Step 2
• Step 3

Step 1

It is a prerequisite that all patients be informed of the risks, benefits, and alternatives to having colonoscopy. Although colonoscopy gives a highly accurate evaluation of your colon, be aware that small polyps or growths can be missed in a minority of patients.

Please review the linked brochure:

If you would like additional information pertaining to your procedure, please review the following:

Make The Best Choice for Endoscopic Procedure

If you have any questions regarding colonoscopy, please contact our Practice Development Coordinator (PDC) at (713) 906-5750 before proceeding to Step 2.

Step 2

Please complete and sign the following forms. For your convenience, you may fill in your information online, print, sign, and mail the forms to our office.

To ensure the privacy of our patients, your data will not be saved upon exiting the web page. If you prefer, you may print the forms first and complete by hand. It is imperative that each form (4 total) is signed in the appropriate areas.

• Patient Registration Form (2 signatures)
• Screening Criteria Check List (1 signature)
• Advance Beneficiary Notice (ABN) (1 signature)
• Informed Consent (2 signatures)

OR

You can download all the forms at once.

Mail documents to:
HGA
attn: PDC
915 Gessner, Suite 625,
Houston, TX, 77024

Step 3

Our patient satisfaction and confidence in our services is our sole priority. We urge you to complete our DAE Satisfaction Survey. This survey, along with a postage paid return envelope, will be provided to you at the time of your procedure. HGA welcomes your feedback. Please help us meet our goal of providing the best medical care for our patients. See why we are one of the leading Gastroenterologists of Houston.

We provide you with the best medical care tailored to your needs.