Patient Information

To help our Staff process your appointment efficiently, please download the appropriate forms, print them out, and bring the completed forms with you at the time of your appointment.

Forms are available in PDF or Microsoft Word formats. If you do not have Adobe Acrobat Reader, you can download it free by clicking on the image below.

New Patients
PDF | Word Doc
Returning Patients
PDF | Word Doc
Procedure Preparation
PDF
Post-Op Instructions
PDF
Pelvic Floor Disorders
PDF | Word Doc
Pre-Endoscopy Questionnaire
PDF
Medicare Waiver
PDF
Colonoscopy Consent
PDF | Word Doc

Privacy Practices

To ensure the safety and confidentiality of your medical information, please download the appropriate forms, print them out, and bring the completed forms with you at the time of your appointment.

All forms are in PDF and Microsoft Word formats. If you do not have Adobe Acrobat Reader, you can download it free by clicking on the image below.

HIPAA Privacy Notice PDF | Word Doc
Privacy Notice Consent PDF | Word Doc

To Schedule an Appointment

Please call the office to schedule an appointment at 407-422-3790 then press 2. Appointments are available between 9:00 am – 5:00 pm Monday through Friday.

Click here for maps to our locations.

In an effort to reduce your waiting time in our lobby you may download the forms below. Please follow these instructions:

1) Download the appointment forms below

2) Complete the forms. Please answer every question.

What to bring with you to your visit
Please arrive 15 minutes prior to your appointment time.

- the completed forms with you to your appointment
- your current insurance card
- your current I.D. card (driver’s license)

You may be asked to perform a “Preparation” prior to your visit. For details click Preparation.

New Patients PDF | Word Doc

Returning Patients PDF | Word Doc

Cancellations

If you are unable to keep an office appointment, we kindly ask that you provide us with at least 48 hours notice. This courtesy on your part will make it possible to give your time to another patient. If you wish to cancel a colonoscopy or surgery kindly do so by calling our office. Please do not cancel by speaking with hospital or laboratory personnel only.

Financial Policy

Co-payments and deductibles are due at the time services are rendered. Forms of payment accepted by our office are cash, check, and all major credit and debit cards.


CRC Orlando supports the mission of CRERI - find out how you can, too! Click here to visit the CRERI website.

Contact CRC Orlando
110 W Underwood St.
Orlando, Fl 32806
(407) 422 - 3790

fax (407) 425 - 4358
email: mkunold@CRCOrlando.com
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The content of the Colon and Rectal Clinic of Orlando website is for informational purposes only. Its contents are not intended to be a substitute for professional medical advice, diagnosis or treatment. Please seek the advice of your physician or other qualified health provider should you have questions regarding a medical condition. Never disregard or delay professional medical advice and treatment because of contents read on the Colon and Rectal Clinic of Orlando website.