New Patient Forms and What to Bring to Your First Visit

Which forms you need before your first visit

Every new patient at Digestive & Liver Center of Arkansas completes a short packet before being seen. Finishing it at home turns a 30-minute check-in into a 5-minute one. Your new patient packet usually includes:

• Patient registration, with your name, date of birth, address, phone number and emergency contact
• Insurance and financial information, including your policy details and who is responsible for the bill
• Medical history, covering your symptoms, past surgeries, other conditions and family history of colon cancer, polyps or liver disease
• Medication list, including prescriptions, over-the-counter medicines, vitamins and supplements
• Consent for treatment
• Notice of Privacy Practices acknowledgment, which confirms you received our HIPAA privacy notice
• Authorization to release records, if you want us to request your records from another office

How to complete your forms ahead of time

Call the office and ask us to send your packet. We can email or mail it, or you may be able to complete it through your patient portal once you are set up. A few tips that save real time:

• Write your medicines down before you start. Names and doses, not just "my blood pressure pill."
• Include supplements. Iron, herbal products and fish oil can matter before a procedure.
• Do not leave the family history blank. A parent, brother, sister or child with colon cancer or polyps can change when your screening should begin.
• Note prior tests. The month and year of a past colonoscopy, endoscopy, liver ultrasound or FibroScan helps us avoid repeating something you have already had.
• Bring the packet with you if you filled it out on paper. Do not mail the only copy. If reading or filling out forms is difficult for any reason, tell us. Our staff will go through them with you at the office, and Dr. Ihab Herraka speaks English and Arabic.

What to bring to your first appointment

• A photo ID
• Your insurance card, plus any secondary, supplemental, Medicare or Medicaid card
• Your completed forms
• A current medication list with doses
• Recent lab work, especially liver enzymes if you are coming for a liver visit
• Imaging reports such as ultrasound, CT or MRI results, if you have them
• The name and phone number of your primary care provider
• A form of payment for any copay
• Any referral or authorization your plan requires

Please arrive 15 minutes early

Plan to be at the front desk 15 minutes before your appointment time. That gives our staff time to verify your insurance, scan your ID and finish anything missing on your paperwork without cutting into your time with the doctor. If you are scheduled for a procedure rather than an office visit, follow the arrival time on your instruction sheet instead; it is usually earlier and accounts for check-in and prep. Our patient resources page covers what to expect for each procedure. Running late or need to reschedule? Call as early as you can so we can offer the slot to someone else and find you a better time.

How records are transferred from another practice

Getting your old records is worth the effort. Prior colonoscopy reports, pathology results, liver imaging and lab trends can spare you a repeat test.

1. Sign a release. Federal privacy law requires your written authorization before another office can send us your chart. We provide the form, or your previous practice may have its own.
2. Tell us exactly what to request. The practice name, city, and the dates or types of records, such as "colonoscopy report and pathology, 2019."
3. Give it time. Most offices respond within one to two weeks. Request records as soon as you book so they arrive before your visit.
4. Bring copies if you have them. A printed report in your hand beats one still in transit. Photos of paper reports are fine too. Need your records sent from us to another provider instead? Contact our office and we will handle the release.

Cost & insurance

Bring your insurance card to every visit, even if nothing has changed. Our staff verifies benefits before procedures and can quote self-pay pricing up front. See our insurance and billing page for the plans we accept.

For referring physicians

Referring a patient? Call our office at (479) 242-2888 with the patient's information, or send us a message online, and our staff will follow up on scheduling and records.