Patient Corner

Helpful, resources, links and forms you may need before you come for a visit at Northeast Digestive

New Patients

To ensure we’re able to provide the best possible care at your upcoming visit, we encourage you to take a few minutes to review our New Patients section prior to your appointment. There you’ll find information on what to expect during your visit, helpful reminders and important information regarding billing and insurance.

patient portal REGISTER NOW

Our Policies

Procedure Prep

How to Prepare for your procedure

Preparing for Colonoscopy

Your Northeast Digestive Health Center provider will provide specific prep instructions at your consultation. The three primary courses ordered for colonoscopy procedure preparation are:

Suprep Instructions (PDF)

Miralax/Gatorade Instructions (PDF)

2 Day Miralax/Gatorade Instructions (PDF)

Clenpiq Instructions (PDF)

Golytely Instructions (PDF)

Plenvu Instructions (PDF)

Preparing for Pill Cam

The course you take to prepare for your colonoscopy will depend on your gastroenterologist, but all patients should prepare to cleanse the bowel completely beforehand and arrange for a ride home – as driving is not allowed for 24 hours following the procedure.

Your Northeast Digestive Health Center provider will provide specific prep instructions at your consultation. The three primary courses ordered for colonoscopy procedure preparation are:

Pill Cam (PDF)

Preparing for Endoscopy

Endoscopic procedures vary in terms of invasiveness, uses and capabilities. Your doctor will provide prep instructions prior to your procedure. The following are procedure prep instructions for the primary types of endoscopy used by Northeast Digestive Health Center’s gastroenterologists:

EGD (Upper Endoscopy) (PDF)

EUS (Endoscopic Ultrasound) (PDF)

ERCP (Endoscopic Retrograde Cholangiopancreatography) (PDF)

Preparing for FibroScan®

It is important to have your FibroScan® examination on an empty stomach. Do not eat anything for at least 3 hours prior to your examination. Wear comfortable clothes that will allow access to the right side of your rib cage. It is important to tell your health care provider if you are pregnant, or if you have any active implantable devices, such as pacemakers, defibrillators or pumps.

*Please note: In order to schedule this procedure, your primary care physician must refer you.

FibroScan® is FDA-approved for clinical management of patients with liver disease and is covered by most insurance carriers. FibroScan® probes are adapted to most body-types patients and to all ages, from pediatric to adults. For more information about this procedure, please contact Northeast Digestive Health Center at (704) 783-1840.

Patient Satisfaction Surveys

Northeast Digestive Health Center is dedicated to providing the best care to our patients and we encourage you to take a moment to share your experience with us.

To participate in our patient satisfaction survey, please choose one of the options below:

Vinehaven Office Survey

Poplar Tent Office Survey

Salisbury Office Survey

Patient Forms

Complete appointment request forms online by clicking on the appropriate links. Once completed and submitted we will contact the patient by phone to schedule.

Patient Open Access Form

See Form

Physician Referral Form

See Form

Release of Information

If you would like us to forward a copy of your medical records to another person or facility, please click on the link below to access our Release of Information form. Print and complete this form and fax to 704-783-1850. You may also drop it off at one of our convenient locations.

You can also use this same form to request that another facility forward their records to us.

See Form

Helpful Resources

Listed below are helpful links to further patient education on specific topics. Please discuss this information with your provider.

The American College of Gastroenterology U.S. National Library of Medicine ASGE AGA

Our Policies

Charity Care Policy

Charity Care:
For the purpose of this policy, charity care is defined as a patient having no financial ability to cover the expenses for needed and scheduled procedures. This determination will be made by the physician providing the services and does not necessarily require level of income documentation. Income documentation may be required at the physician’s discretion in collaboration with the Practice Manager.

Patients will be accepted and treated on an as needed basis upon referral from primary care physicians that we normally receive referrals from within our demographic regions. We will also consider direct referrals for procedures from charitable organizations in the community.

Private Pay / Self Pay:
Private pay / self pay is defined as the patient who does have the financial ability to pay all or part of the expenses for needed or scheduled procedures. This includes patients who have health insurance, but choose not to file their expense through their health insurance and prefer to self pay for the procedure.

The determination of the fee schedule for private pay patients assumes that the patient is responsible for some or all the incurred expenses. Self-pay patients will receive a 25% discount based off the charge amount for all procedures (EGD, Colonoscopy, ERCP, etc.). New office visits will cost $200.00 and established office visits will cost $100.00 per visit. This determination has been approved by the governing board and may change from time to time. The practice will discuss this with patients before their procedure or office visit.

Nondiscrimination Notice Policy

This center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

This center provides free aids and services to people with disabilities to communicate effectively with us via written information in other formats (large print, audio, accessible electronic formats, other formats) and free language services to people whose primary language is not English, such as translation websites or phone services and information written in other languages

If you need these services, please notify any staff member. If you believe that this center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the Manager by calling our main phone number.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the:

Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or
by mail or phone.

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Department of Health and Human Services, 1-800-368-1019, 800-537-7697 (TDD)
200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201

Getting Help in a Language Other Than English

Español (Spanish)
ATENCIÓN: Si usted habla español, tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al número de teléfono marcado “customer service” en el dorso de su tarjeta de identificación de miembro [TTY/TDD: 711].

中文 (Traditional Chinese)
注意：如果您講中文，我們免費提供相關的語言協助服務。請致電您會員卡背面標記為“customer service”的電話號碼 [TTY/TDD專線：711]。

Pусский (Russian)
ВНИМАНИЕ! Если Вы говорите на русском языке, Вам доступны бесплатные услуги переводчика. Звоните в отдел обслуживания клиентов (customer service) по номеру телефона, указанному на обратной стороне вашей карточки (служба текстового телефона, TTY/TDD: 711).

Kreyòl Ayisyen (Haitian Creole)
ATANSYON: Si ou pale Kreyòl Ayisyen, gen sèvis èd nan lang, gratis, ki disponib pou ou. Rele nimewo telefòn ki make “customer service” ki nan do kat ID manm ou [TTY/TDD: 711].

한국어 (Korean)
주의: 귀하가 한국어를 사용하는 경우, 귀하에게 언어 지원 서비스가 무료로 제공됩니다. 회원 ID 카드의 뒷면에 "customer service"라고 표시된 전화번호[TTY/TDD: 711]로 연락해 주십시오.

Italiano (Italian)
ATTENZIONE: Sono disponibili servizi gratuiti di assistenza linguistica in italiano. Chiami il numero del “customer service” stampato sul retro della sua carta socio [TTY/TDD: 711].

אידיש (Yiddish)
מעלדונג: אויב איר רעדט אידיש, שפראך הילף סערוויסעס, אהן קיין פרייז, זיינען דא צו באקומען פאר אייך. רופט דעם טעלעפון נומבער גערופן "customer service" אויף אייער קארטל [TTY/TDD: 711].

বাাংলা (Bengali)
দৃষ্টি আকর্ষণ করছি: আপনি যদি বাংলা ভাষী হন, আপনার জন্য, বিনামূল্যে ভাষা সহায়তা রয়েছে। আপনার মেম্বার আইডি কার্ডের পেছনে “customer service” চিহ্নিত টেলিফোন নম্বরে [TTY/TDD: 711] ফোন করুন।

Polski (Polish)
UWAGA: Dla osób mówiących po polsku dostępna jest bezpłatna pomoc językowa. Zadzwoń do „customer service” pod numer telefonu podany na odwrocie karty identyfikacyjnej ubezpieczonego [TTY/TDD: 711].

العربية (ARABIC)
يرجى الانتباه: إذا كنت تتكلم اللغة العربية، تتوفر لك خدمات المساعدة اللغوية مجاناً. اتصل عبر رقم الهاتف المشار اليه "customer service" الموجود على ظهر بطاقة عضويتك [TTY / TDD: 711].

Français (French)
ATTENTION : Si vous parlez français, une assistance d’interprétation gratuite est à votre disposition. Veuillez composer le numéro « customer service » au dos de votre carte de membre [Sourds et malentendants : 711].

اردو (Urdu)
توجہ دیں: اگر آپ اردو زبان بولتے ہیں تو، آپ کے لیے زبان سے متعلق اعانت کی خدمات، مفت دستیاب ہیں۔ اپنے ممبر آئی ڈی کارڈ کی پشت پر موجود "customer service" والے ٹیلیفون نمبر پر کال کریں [ ٹی ٹی وائی/ ٹی ڈی ڈی:711]

Tagalog (Tagalog)
NANANAWAGAN NG PANSIN: Kung nagsasalita ka ng Tagalog, mayroon kang magagamit na mga serbisyo para sa tulong sa wika nang walang bayad. Tumawaglamangposateleponong may tatakna “customer service” salikod ng inyong member ID card [TTY/TDD: 711].

Ελληνικά (Greek)
ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας δωρεάν υπηρεσίες γλωσσικής βοήθειας. Καλέστε τον αριθμό με την ένδειξη «customer service» στο πίσω μέρος της κάρτας μέλους σας [Για βαρήκοους/Κωφούς – TTY/TDD: 711].

Shqip (Albanian)
VINI RE: Nëse flisni Shqip, shërbimi i asistencës për gjuhën do të jetë në dispozicionin tuaj, pa pagesë. Telefononi në numrin ku shkruhet ‘‘customer service’’, i cili gjendet ne anën e pasme të kartës tuaj identifikuese të anëtarësisë [Shërbimi rele TTY/TDD: 711].

Patient Corner

New Patients

Patient Corner Quick Links

Procedure Prep

How to Prepare for your procedure

Preparing for Colonoscopy

Preparing for Pill Cam

Preparing for Endoscopy

Preparing for FibroScan®

Patient Satisfaction Surveys

Patient Forms

Release of Information

Helpful Resources

Our Policies

Charity Care Policy

Nondiscrimination Notice Policy

Easy Appointment Booking

Quick Links

Patient Resources

Helpful Links

Contact Info