If you have any questions regarding the Patient Forms feel free to contact our main office at 732-702-1039.
New
Patient Registration Packet
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
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 Choose Your Procedure Below to Open/Download
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
Allied Digestive Health has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.
Once you enter your email, you will receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You will receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Is there a cost associated with obtaining my medical records?
HealthMark Group fulfills all requests for personal copies at no charge. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.
About
Our GI Care
For Your Visit
Englewood Office
420 Grand Avenue,
Suite 101,
Englewood, NJ 07631
P: 201-569-7044
Mon – Tues: 8:00AM – 7:00PM
Wed: 8:00AM – 6:00PM
Thurs: 8:00AM – 7:00PM
Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
Englewood Cliffs Office (140 Sylvan Ave.)
140 Sylvan Avenue, Suite 101A,
Englewood Cliffs, NJ 07632
P: 201-945-6564
Mon – Tues: 8:00AM – 7:00PM
Wed: 8:00AM – 6:00PM
Thurs: 8:00AM – 7:00PM
Fri: 8:00AM – 5:00PM
Sat & Sun: Closed
Englewood Cliffs Office (270 Sylvan Ave.)
P: 201-568-6222
270 Sylvan Ave
Suite 1160,
Englewood Cliffs, NJ 07632
Mon – Fri: 8:00AM – 4:00PM
Sat & Sun: Closed
Edgewater
P: 201-945-6564
235 Old River Road
Edgewater, 07020
Mon – Tues: Closed
Wed: 1:30PM – 3:30PM
Thurs – Sun: Closed
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