Dr Kassamo Dayemo

Home Patients Procedures Education Contact Us
digestive and liver disease care
Upon arrival for your appointment, you will be asked to complete the following 5 forms.
For your convenience, you may print and fill them out and bring them with you.
  1. Patient Registration
  2. Visit Questionnaire
  3. Health Questionnaire
  4. Payment Policy
  5. HIPPA Notice of Privacy Practices
  6. Prep for EGD Form
  7. Prep for Capsule Endoscopy
  8. Prep for Colonoscopy
  9. Procedure Payment Policy
  10. Referring Physician Appointment Form
  11. Financial Policy

These forms are in Adobe Reader (pdf) format.

Adobe Reader

What to expect

EGD (Upper Endoscopy)
Usually EGD or upper endoscopy is uneventful. Very rarely the patient may experience nausea and vomiting. Patient also may experience cramping abdominal pain. Bloody vomiting is unlikely. However, in rare occasions patient has persistent bloody vomiting. Call office or go to emergency room.

Complications are rare. Patients may experience abdominal pain, rectal bleeding and abdominal distention. Colon perforation is a very rare complication. Patient may not have a bowel movement for up to 5 days after a colonoscopy.
1606 Ashley River Road
Charleston, SC 29407
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