Open Access Colonoscopy

The typical patient:
  • Is under age 65
  • Has no serious  chronic medical problems
  • Has had a physical exam within the past 12 months
Reasons for a necessary office visit/prescreen appointment:
  • Age 65 and over
  • No physical exam within the last 12 months
  • History of heart disease, heart attack, or endocarditis
  • Heart valve replacement
  • Pacemaker/Defibrillator/Stent
  • On anticoagulation therapy (Coumadin, Plavix, Heparin, Ticlid, Lovenox)
  • History of kidney disease
  • History of chronic pulmonary problems (chronic asthma, emphysema, COPD)
  • Joint replacement within 2 months
  • Recent prominent change in bowel habits
  • Anemia
  • Mobility problems, paralysis, stroke, Parkinson’s, TIA’s
  • New patient EGD (usually has symptoms which require an office visit)
  • History of diabetes
  • Weight > 350
  • Alcohol or drug dependency
  • Abdominal pain

NOTE:This form is only for use by NEW patients who qualify to have an endoscopy procedure without a prior consultation. DO NOT complete this form if you are already an ESTABLISHED patient at Mesa GI.