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Jackson County Gastroenterology
Home
About
Our Staff
Gregory M. Vardakis, DO
Farid M. Namin, MD
All Staff
Conditions Treated
Abdominal Pain
Barrett’s Esophagus
Blood in Stool
Colon Polyps & Cancer
Constipation
Diarrhea
Difficulty Swallowing
Diverticulosis
Gas / Bloat
GERD
Hepatitis C
All Conditions
Procedures
Endoscopic Ultrasound
Lactulose Breath Test
HALO Ablation
Hydrogen Breath Test Procedure
H. pylori Breath Test
ERCP
Upper Endoscopy (EGD)
Colonoscopy
Capsule Endoscopy (small bowel)
Remicade Infusion Therapy
All Procedures
Resources
Insurance Information
Financial Policy
No Show/Cancellation Policy
Patient Forms
Frequently Asked Questions
All Resources
Contact
Book An Appointment
Jackson County Gastroenterology
Home
About
Our Staff
Gregory M. Vardakis, DO
Farid M. Namin, MD
All Staff
Conditions Treated
Abdominal Pain
Barrett’s Esophagus
Blood in Stool
Colon Polyps & Cancer
Constipation
Diarrhea
Difficulty Swallowing
Diverticulosis
Gas / Bloat
GERD
Hepatitis C
All Conditions
Procedures
Endoscopic Ultrasound
Lactulose Breath Test
HALO Ablation
Hydrogen Breath Test Procedure
H. pylori Breath Test
ERCP
Upper Endoscopy (EGD)
Colonoscopy
Capsule Endoscopy (small bowel)
Remicade Infusion Therapy
All Procedures
Resources
Insurance Information
Financial Policy
No Show/Cancellation Policy
Patient Forms
Frequently Asked Questions
All Resources
Contact
Book An Appointment
Home
About
Folder: Our Staff
Back
Gregory M. Vardakis, DO
Farid M. Namin, MD
All Staff
Folder: Conditions Treated
Back
Abdominal Pain
Barrett’s Esophagus
Blood in Stool
Colon Polyps & Cancer
Constipation
Diarrhea
Difficulty Swallowing
Diverticulosis
Gas / Bloat
GERD
Hepatitis C
All Conditions
Folder: Procedures
Back
Endoscopic Ultrasound
Lactulose Breath Test
HALO Ablation
Hydrogen Breath Test Procedure
H. pylori Breath Test
ERCP
Upper Endoscopy (EGD)
Colonoscopy
Capsule Endoscopy (small bowel)
Remicade Infusion Therapy
All Procedures
Folder: Resources
Back
Insurance Information
Financial Policy
No Show/Cancellation Policy
Patient Forms
Frequently Asked Questions
All Resources
Contact
Book An Appointment

Patient Forms

 

Click to download our Patient Forms in the list below.

Print, complete and bring the forms with you to your next appointment.

If you don’t have Adobe Reader on your computer, click here for a free download: Get Adobe Reader

  • Medical History Form | Click to Download

  • Review of Symptoms | Click to Download

  • Medication List | Click to Download

  • Genetic Testing Form | Click to Download

  • Outside Testing Consent | Click to Download

  • Privacy Notice Acknowledgement | Click to Download

Independence Location

18640 E. 38th Terrace South
Independence, MO 64057

 

Hours

Monday — Friday: 8:00am — 4:30pm

Saturday — Sunday: Closed

Connect with Us:

Call Us for Consultation

(816) 229-1191

Book An Appointment/Procedure
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About
Our Staff
Conditions Treated

Procedures
Resources
Contact


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