Direct Scheduling Colonoscopy

You have been asked by your physician to schedule a screening colonoscopy through our office.  It is imperative that we receive a referral form from your primary care physician before starting the process.  The referral form should attest that you are in good health and can proceed with the colonoscopy without further assessment in our office. 

This scheduling venue is intended to lessen the need for a pre-procedure office visit.  We will review the health information we would normally review during an office visit by having you complete the forms attached and returning them to us.  We will go over your information and contact you.  On the day of your procedure, Dr. Marwan Balaa will examine your heart, lungs and abdomen. 

Not everyone is a candidate to go the route of Direct Scheduling Colonoscopy. This scheduling process is intended for patients who have been deemed, by their Primary Care Physicians to be in good health, and who, after reading the description of the procedure on this site, feel comfortable and familiar enough with the procedure, and for those patients who have had a colonoscopy in the past.  Our careful review of your health history will be key in determining whether you need to be seen in the office for a pre-colonoscopy visit. You may, on the other hand, choose to be seen in our office for a pre-procedure evaluation irrespective of your health history. Please call us at 408-402-9990 and we will gladly schedule an office visit for you. 

New Patients

In order to simplify the scheduling process we ask that you read and familiarize yourself with the attached documents.  Please complete the forms and return them to our office.

  • New Patient Registration Form
  • Health Questionnaire
  • Signed and dated HIPPA Document
  • Signed and dated Consent Form
  • Signed and dated Rights of Patients Form
  • Signed and dated Cancellation Notice

Please download the forms below and return them to us via:

  • E-mailScheduling@GutCare.com\
  • Fax:  408-402-0330
  • Mail
       Marwan A. Balaa, MD
       Direct Colonoscopy Program
       2520 Samaritan Dr.  Ste. 201
       San Jose, CA.  95124 

Upon receipt of the forms, we will review them and conduct a phone interview with you.  The process for preparation prior to the procedure will be discussed with you at that time.  The procedure will be scheduled soon thereafter. 

 

New Patient Forms

New Patient Registration Form
Health Questionnaire
HIPAA Form
Consent Form for Colonoscopy
Rights of Patients  

Reading and other important information

Understanding Colonoscopy
Preparation for Colonoscopy - Using MoviPrep
Preparation for Colonoscopy - Using Prepopik
How to make the cleansing procedure more tolerable Colon_preparation_easier
Clear Liquid Diet
Colonoscopy Quality Measures