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Polyp Information Sheets for Referring Physicians

NM PPISTo assist referring physicians in educating their patients who’ve had a polyp removed during colonoscopy, ASGE created a polyp information sheet that explains what a polyp is and provides general information on follow-up exams.

Instructions:
Following is a link to the referring physician polyp sheet, which is easily downloadable. You may choose to print hard copies to write on manually or you may fill in the gray shaded boxes electronically.

The sheet is two pages in length; It is best to print double-sided so that the patient/physician has just one sheet of paper to retain.



NOTE TO PHYSICIANS:
Do not download these forms unless you agree to the following terms.

  • By downloading the form, you are agreeing to hold ASGE harmless against any costs, claims, damages, and expenses, including attorney fees, arising from the use of the form.
  • You are also agreeing not to modify any of the educational content provided by ASGE in the form.
  • You may modify the “blank” sections to communicate any notes from the patient's visit or phone call and fill in your contact information.

CLICK HERE TO DOWNLOAD SHEET

If you have any questions about the use of this form, please contact ASGE’s PR Manager, Anne Brownsey, at abrownsey@asge.org.