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Before Your Procedure

It is essential that all patients bring their updated ID and insurance cards to their appointment

Prior to your procedure, we need to collect some demographic and clinical information so that your physician has everything necessary to give you the best possible care. Please complete the following steps prior to your scheduled visit:

Pre-Procedure Patient Forms

Please print, complete and bring these forms to your procedure appointment.

Pre-Procedure Patient Forms

Insurance and Consent Forms

There are a few additional items (insurance information, consent forms, etc.) that are not covered by the Portal that we need to obtain prior to your visit. Click on the link to download the forms, then print and complete them and bring them with you to your appointment. If you already did this for a previous visit within the past year, you can skip this step unless your personal or insurance information has changed.

Insurance and Consent Forms

**NOTE: Use of perfumes, colognes, and scented lotions are not permitted in Gastro One offices.

IMPORTANT MEDICATION INFORMATION

  • The following medications should be held as instructed prior to procedure: Phentermine: Adipex-P, Qsymia, and Lomaira (Daily) – These medications will need to be stopped seven (7) days prior to your procedure.
  • GLP-1 MEDICATION – All GLP-1 medications, including those listed below, will need to be stopped seven (7) days prior to your procedure if you are on a weekly dose or the day of your procedure if you are on a daily dose.
    • Dulaglutide: Trulicity (Weekly)
    • Exenatide: Bydureon (Weekly) and Byetta (Daily)
    • Liraglutide: Victoza (Weekly) and Saxenda (Daily)
    • Lixisenatide: Adlyxin (Daily) and Soliqua (Daily)
    • Semaglutide: Ozempic (Weekly), Wegovy (Weekly) and Rybelsus (Daily)
    • Tirzepatide: Mounjaro (Weekly) and Zepbound (Weekly)
  • PRESCRIBED MEDICATION: Unless otherwise informed, take your usual prescribed medications with no more than two (2) tablespoons / one (1) ounce of water up to three (3) hours prior to your appointment time.
  • DIABETIC MEDICATION:
    • If you take oral medications for your diabetes, DO NOT take your diabetes pills on the day prior to your procedure or on the day of your procedure (until your procedure is complete and you resume a normal diet).
    • If you take non-insulin injectable medications (Byetta, Bydureon, Victoza, Trulicity, Tanzeum, Symlin), DO NOT take the medication if your injection day is the day prior to your procedure. You can resume it after the procedure is complete.
    • If you take insulin, reduce your dose by 50% (half) of your normal dose on the day prior to your procedure and the day of your procedure. You can resume your normal dose after the procedure when you resume normal diet.
    • If you use an insulin pump, contact your diabetes doctor for instruction. Generally, most patients will need to reduce their basal rate to 80% of the normal rate.
  • BLOOD THINNERS: If you are taking a blood thinner prescribed by a physician (such as Coumadin, Plavix, Effient, Eliquis or Ticlid), your gastroenterologist will need to determine if these medication dosages require adjustment prior to the procedure. Failure to properly adjust these medications may result in cancellation of your procedure. You may continue to take Aspirin as usual.
  • ASTHMA: If you have asthma, please bring your inhaler with you.

BRING A DRIVER

Bring an adult driver. Your driver must be 18 years of age or over and they must stay in the Endoscopy Center. You will be given a sedative for your test, and you are not to drive until the next day. Therefore, one person must stay and drive you home. Your procedure will be rescheduled if your driver cannot stay in the Center.

NOTIFY US IN ADVANCE

  • If you are having chest pain, undergoing cardiac testing, or have pending cardiac tests. (IMPORTANT: Please notify us before you begin to prep for your procedure.)
  • If you have had any recent hospitalizations.
  • If you have ever had excessive bleeding after an operation or problems with anesthesia.
  • If there is a possibility you are pregnant.

DO NOT

  • DO NOT take iron, diet pills (Phentermine, Adipex or Qsymia), GLP weekly injections, or herbal medications for seven (7) days prior to having your procedure. You may take vitamins.
  • DO NOT drink alcohol for 24 hours before or after your procedure.
  • DO NOT use items such as gum, hard candy, breath mints, smokeless tobacco, or illicit drugs such as marijuana on the day of your procedure.
  • DO NOT smoke tobacco, marijuana, vape, or chew tobacco on the day of your procedure.
  • DO NOT drink liquids that are not clear such as milk or creamer.
  • DO NOT drink liquids that are red or purple in color.
  • DO NOT eat solid food the day of your procedure. If you are having a colonoscopy, DO NOT eat solid food the day before your colonoscopy and the day of your procedure.

DENTURES

If you have dentures, you may be required to remove them for the procedure.

PIERCINGS

If you have body piercings, you will be asked to remove them prior to the procedure for your safety.

RESCHEDULING

If you need to reschedule your procedure, please call your physician’s office at least 3-4 days in advance so that we may schedule another patient in your appointment time. If you cancel within 72 hours of your procedure appointment or are a no-show, there is a $100 late-cancellation fee.

It is essential that all patients bring their updated ID and insurance cards to their appointment

Prep for Procedure