Resources for Patients - Atlantic Coast Gastroenterology Associates

Patient Forms

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

First Visit

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.

Please Bring The Following Items With You To Your Visit

Most current insurance card(s)
Driver’s license or photo identification
Co-payment in the form of cash, check or credit card
A complete listing of your medication, including dosages
If you have seen a Gastroenterologist in the past and/or have had prior diagnostic testing done CT scan, x-ray, lab work, etc.), please have those records forwarded to us in advance or bring with you to your appointment.
Ensure that our office has received a referral, if necessary, in advance of your appointment.
It is important that you arrive at your appointment early and allow ample time for the check-in process. We cannot predict how long it will take each individual to complete the process; therefore, please arrive according to the suggestions below:
New patients and those not seen in over 1 year – 30 minutes
Existing patients – 15 minutes
Procedures – 30

Preparation Instructions

Colonoscopy -

Dr. Basri Preparation Instructions -

Insurance & Billing

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

View Our List Of Accepted Providers

Medicare
Horizon Blue Cross and Blue Shield
Aetna
Cigna
United Healthcare
Oxford
US Healthcare
and many others.