Online Colonoscopy Screening Form

Thank you for your interest in our colonoscopy screening service.

Please fill out the form below, and a representative will contact you at the phone number you provide within two business days to schedule your appointment.

Colonoscopy screenings are performed in the Endoscopy Center at Columbus Regional Health.

First Name

Middle Initial

Last Name

Best Phone Number to Call

Best Time to Call

Morning
Afternoon

Email Address

Gender

Male
Female

Date of Birth

First colonoscopy?

Yes
No

Street Address

Innovation

Why Columbus Regional Health?

100 Years of Caring

Thank you for your interest in our colonoscopy screening service.

Brad's Story