Direct Schedule Screening Colonoscopy Referral Form

In order to facilitate your patient in a timely manner please email or fax the following information:

1. This Direct Schedule Screening Colonoscopy Form
2. Current medical records along with recent labs
3. Patient demographic/Insurance info/Referral Sheet

If you have questions about uploading into the Leading Reach/FibroBlast Referral platform, please call our office at (469) 697-5100.

Did you know that you can download the PDF form and email the information to [email protected] or Fax to (469) 697-5105

Thank you for entrusting Dr Maddala with your patient’s health care needs and supporting us in the prevention of colorectal cancer!