If you have any questions regarding the Patient Forms feel free to contact our main office at 732-702-1039.
Patient Registration Form
Consent for Use and Disclosure of Protected Health Information
Patient Financial Responsibility Statement
Card on File Agreement
Notice of Privacy Practices
HIPAA Consent
Office Policies
Medical Procedure Billing Form
Medical Records Release Form
Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.
Colonoscopy -
Dr. Basri Preparation Instructions -
Our office participates in many insurance plans. If your insurance plan is not listed, please call your insurance company to confirm participation.
For additional information regarding out-of-network benefits, plan-specific information, or other billing and insurance inquiries, the following contact will gladly assist you.
The main number for billing inquiries for Allied Digestive Health is: (732) 702-1039
Allied Digestive Health has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.
Once you enter your email, you will receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You will receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Is there a cost associated with obtaining my medical records?
HealthMark Group fulfills all requests for personal copies at no charge. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.
Our office participates in many insurance plans. If your insurance plan is not listed, please call your insurance company to confirm participation.
For additional information regarding out-of-network benefits, plan-specific information, or other billing and insurance inquiries, the following contact will gladly assist you.
The main number for billing inquiries for Allied Digestive Health is: (732) 702-1039
About
Our GI Care
For Your Visit
Brick Office
P: 732-458-8300
Brick Medical Arts Building
1640 Route 88, Suite 202
Brick, New Jersey 08724
Mon – Fri: 8:30AM – 5:00PM
Sat & Sun: Closed
Neptune Office
P: 732-776-9300
Jersey Shore Medical Arts Building
1944 Corlies Ave. Suite 205
Neptune, New Jersey 07753
Mon – Fri: 8:30AM – 5:00PM
Sat & Sun: Closed
Jackson Office
P: 732-928-2300
706 Bennetts Mills Road
Jackson, New Jersey 08527
Mon – Fri: 8:30AM – 5:00PM
Sat & Sun: Closed
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