Guardianship Information and Consent Forms

 

Concord Endoscopy Center

If you are a Legal Guardian for patient that is having a procedure at the Concord Endoscopy Center, please print and complete the following forms that coincide with the type of procedure that is being performed. Also, a copy of the Legal Guardianship paperwork is required.

pdf Colonoscopy Procedure
pdf Esophagogastroduodenoscopy (EGD) Procedure
pdf Flexible Sigmoidoscopy Procedure



Concord Hospital

If you are a Legal Guardian for patient that is having a procedure at Concord Hospital, please print and complete the following forms. Also, a copy of the Legal Guardianship paperwork is required.

pdf Treatment Authorization
pdf Operative Procedure Consent



Monadnock Community Hospital

If you are a Legal Guardian for patient that is having a procedure at Monadnock Community Hospital, a copy of the Legal Guardianship paperwork is required.

 


 

Once the forms have been completed, they can be mailed to:

GI Associates of NH
60 Commercial Street, Suite 404
Concord, NH 03301

Or faxed to: 603-228-7088
Or you can bring them with you on the day of your procedure.

If you have any questions, please contact the GI Associates of NH at (603) 228-1763.