Book a Colonoscopy

Our Providers

What do I do now?

1. Please contact your Primary Care Provider and get the necessary referral. Fax the referral to 860-493-6524

Once you have the referral we will work with you to arrange a suitable time.

Meanwhile you can:
2. Select which of our care providers you wish to get an appointment with.

3. Tell us about your insurance. This will save time later.

EMERGENCY: DIAL 911

Tell us about you

FIRST NAME		LAST NAME

YOUR DATE OF BIRTH


YOUR EMAIL


YOUR CELL PHONE

CHECK IF THIS IS NOT A CELL PHONE

YOUR PRIMARY CARE PHYSICIAN


YOUR DOCTOR'S OFFICE LOCATION


YOUR DOCTOR'S OFFICE PHONE



CHECK IF YOU ARE A NEW PATIENT

Tell us your preference for Provider



Tell us about your insurance

YOUR INSURANCE


HEALTH PLAN PROVIDER IF NOT MEDICAID OR MEDICARE


HEALTH PLAN NUMBER


SUBSCRIBER/MEMBER ID


GROUP NUMBER







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