If you have any questions regarding the Patient Forms feel free to contact our office at (973)667-6444 (Nutley) or (973)376-2121 (Millburn).
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
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.
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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: (973)667-6444 (Nutley) or (973)376-2121 (Millburn).
For Your Visit
Millburn
P: 973-376-2121
116 Millburn Avenue
Millburn, NJ 07041
Mon – Fri: 9:00 AM – 5:00 PM
Sat & Sun: Closed
Nutley
P: 973-667-6444
614 Franklin Avenue
Nutley, NJ 07110
Mon – Fri: 9:00 AM – 5:00 PM
Sat & Sun: Closed
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