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Liberty Endoscopy
646.215.2244
156 William St., 4th Floor, New York, NY 10038

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646.215.2244
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  • About Us
    • Our Facility
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    • Giving Back
  • Meet the Team
    • Physicians
      • Dr. Alexander Abdurakhmanov
      • Dr. Sergey Terushkin
      • Dr. Tianyi Lu
      • Dr. David Hong
      • Dr. Valerie A. Gustave
      • Dr. Deborah L. Chua
      • Dr. Veronika Dubrovskaya
      • Dr. Michael P. Glick
      • Dr. Neal Joseph
      • Dr. Martin J. Wolff
      • Dr. James A. Kim
      • Dr. Max Pitman
      • Dr. Jessica Kimmel
    • Anesthesiologists
    • Nurses & Technicians
    • Administrative Staff
    • Leadership Team
  • Procedures
    • Colonoscopy
    • Sigmoidoscopy
    • Upper Endoscopy
  • Preparing For Your Visit
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Patient Forms

Patient Forms

In order to better prepare you for your visit, below are links to some of the information that we will provide you at the date of your procedure.

Download our forms (PDF format):

Notice of Privacy Practices
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Patient Rights & Responsibilities
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Patient Escort Policy
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Procedure Consent
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Anesthesia Consent
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Acknowledgement of Privacy Practices
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Financial Responsibility Consent
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LEC Brochure
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Medical Records Release Form
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NYS DOH Patient's Bill of Rights
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Spanish:

Notice of Privacy Practices
Learn More »
Patient Rights & Responsibilities
Learn More »
Anesthesia Consent
Learn More »
Procedure Consent
Learn More »
Financial Responsibility Consent
Learn More »
Acknowledgement of Privacy Practices
Learn More »

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Test & Procedures

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Colonoscopy

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Sigmoidoscopy

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Upper Endoscopy

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Preparing for your Visit

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156 William St., 4th Floor, New York, NY 10038
646.215.2244
646.215.2245
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