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What is the ColonoscopyAssist Program About?

  • The ColonoscopyAssist program promotes colon cancer screening among the uninsured community
  • The following tests are provided at heavily discounted rates:
    1. Colonoscopy
    2. Upper Endoscopy
    3. Cologuard
    4. FIT
  • Financial assistance is provided to patients unable to afford the tests.
  • The program focuses on removing financial barriers to CRC screening.

 

 

Release of medical records

 

Release of medical records

This release authorizes any licensed physician, medical practitioner, hospital, clinic, or other medical or medically related facility that has knowledge of me or my health to furnish medical records to:







ColonoscopyAssist Program
8150 Springwood Drive, Suite 190,
Irving, TX 75063,
Tel : (855) 542 6566,
Fax: (847) 984 1164







Please release copies of my records to ColonoscopyAssist

Patient Name : ___________________________ (DOB: _________)
Date Signed : __________________________________________