First Name

Last Name

Date of Birth

Your Email

Office Location
---BraseltonBufordGainesvilleDemorestDawsonville

Performing Physician:
---Scott A. Clark, MDSheraj Jacob, MDJohn L Kalarickal, MDNamita Pareek, MDVinni M. Reddy, MDNeeraj Sharma, MDAndrew Lake, MDMeredith Henley, PA-CNickola Booker, PA-CMarla Dixon, PA-CJoanna Harkness, NP-CErika Holloway, PA-CJamie Majors-NP-CAmy Weber, ANP-C

Testimonial*

Agreement/E-Signature Disclaimer
Gastroenterology Associates of Gainesville, P.C. are committed to respecting the privacy and confidentiality of your health information. Information collected here will solely be used for internal purposes.Gastroenterology Associates of Gainesville, P.C.and its affiliates will retain my name and contact information for records only, and will not disclose or sell my name or contact information to any other companies or individuals. While your name and contact information is preferred anonymous submissions are accepted. I agree that I have provided this submission to Gastroenterology Associates of Gainesville, P.C.and have received no payment or compensation for this submission. By clicking “I agree to these conditions” below, I hereby give Gastroenterology Associates of Gainesville, P.C., its subsidiaries, representatives, employees, and clients the right and permission to use my testimonial for promotional purposes. I also understand that my submission may be edited to correct any spelling and/or grammatical errors. I agree to these conditions. Important: After submission, please do not leave this form until you see the confirmation message.

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