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WestGlen Endoscopy CenterWestGlen Endoscopy Center

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Patient Forms

At WestGlen Endoscopy Center, your time is as valuable to us as it is to you. That’s why we provide online access to a variety of forms that patients may complete before their visit. The following documents will help us expedite the check-in process for your appointment. Please take a moment to download and print the appropriate form(s).

What do I need to bring the day of my procedure?

  • Your insurance card(s).
  • Driver’s License or Photo ID.
  • A list of your current medications.
  • A portion of your procedure payment.
  • Wear comfortable, loose fitting clothes.
  • Plan to arrive at the center 30 minutes prior to the procedure. You should expect a stay of an hour and a half to two hours total.
  • If you’re younger than 18, you must have a parent or guardian accompany you to sign your paperwork. If you are an adult who is unable to sign the consent, you must have someone with you who is authorized to sign on your behalf.
  • Bring someone 16 years or older with a valid driver’s license who can stay at the center during your procedure and drive you home afterward. Your driver MUST stay in our waiting room during your procedure and can sit with you during.

Financial Agreement

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Patient Information Form

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Authorization Form

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Authorization Form – Spanish

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Notice of Privacy Practices

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Notice of Privacy Practices – Spanish

Download

Patient Rights Brochure

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WestGlen Endoscopy Center
16663 Midland Drive, Suite 200,
Shawnee, KS 66217

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