Rizwana Thanawala, MD
Mitchell Duterte, MD
Shawn Waugh, MS, PA-C
Ji Eun Kim, PA-C

4367 NW American Lane
Lake City, FL 32055
Ph: 386.758.6094
Fax: 386.243.8152
Office Hours:
Mon.-Thurs. 8:00am-5:00pm
Fri. 8:00am-4:00pm

Gastroenterology Associates of North Florida
Patient Information
Forms NOTE: To fill out all Patient Information forms online please START HERE and it will take you through the form process. There are four forms and as you fill out and click submit it will take you to the next form. It only takes a few minutes but will save you time at your office visit or right click your mouse on Download PDF and Save Link. Print, fill out, and bring to your first appointment.

Individual Patient Forms
1.Patient Health History and Insurance (Online)                                  DOWNLOAD PDF
2.Acknowledge of our Notice of Practices (Online)                            DOWNLOAD PDF
3.Standard Authorization of use and Disclosure of PHI (Online)      DOWNLOAD PDF
4.Statement of Patient Financial Responsibility (Online)                   DOWNLOAD PDF
5.Patient Registration Forms (Download Only)                        DOWNLOAD PDF

These PDF documents are for Informational purposes. Click on file to open and view.

Colonoscopy Preparation
Colonoscopy Preparation (NuLytely)
Bowel Preparation (Magnesium Citrate)
EGD Preparation
Surgery Center Directions
HIPAA Notice of Privacy Practices

*If you do not have a PDF reader download Foxit FREE Secure Reader®.

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Privacy Policy :: HIPAA Notice of Privacy Practices
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