Patient Forms

Kevin H. Ashby, MD Contents Patient Forms

 

Cancellation/ No Show Policy for Doctor Appointment

We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment, you may be preventing another patient from getting much needed treatment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a heavily committed schedule. If an appointment is not canceled at least two (2) business days in advance you will be charged a one-hundred dollar ($100) fee for a New Patient Consultation or a fifty dollar ($50) fee for a Follow Up Visit; this will not be covered by your insurance company.

Cancellation Form

Patient Registration Forms

Kevin Ashby, MD welcomes you to our gastroenterology practice, located in Irvine, Laguna Hills, and Foothill Ranch, California. Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process. Please be sure to bring all forms with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another provider.Downloadable Forms

Colonoscopy Preparation Instructions

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