Procedures Center

Forms for Endoscopy Procedures

Gather and Complete the Following Forms and Bring Them With You

  • Health History Form
  • Patient Home Medication List: If you are unsure of the names, check the original pharmacy container, which will include the dosage and how often you should take the medication. Be sure to include this information on the Medication List. In addition, record the last time you took each medication with the date and time. Be sure to include any allergies you have to medications, foods, latex, or x-ray contrast dye.
  • If you have a Health Care Proxy or Living Will, please bring a copy with you.
  • Your health insurance cards
  • Any x-ray films requested by you doctor

Highland Procedures Center


Phone: (585) 341-6877
Fax: (585) 341-8453

Pain Management

Phone: (585) 244-7748
Fax: (585) 244-7610

Blood Transfusions

Phone: (585) 341-0078
Fax: (585) 341-8453

Highland Hospital
1000 South Avenue
Rochester, NY 14620
Main Line: (585) 473-2200

Directions to Highland Procedures Center

Google Map to North Lot