Our Services
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A Resource for Primary Care Providers

The vision of Lancaster Gastroenterology's Heartburn Clinic is to be the first choice for primary care providers in our region to refer patients who suffer from GERD in an effort to dramatically reduce its complications including esophageal cancer.

In addition to on-line scheduling availabe on our website, we have made our faxable appointment forms available for download below.

Referral Forms

Appointment Referral Form
download

Please print and fax this form to request a patient appointment.

Express Scheduling Fax Form
download

Please print and fax this form to request express scheduling for an upper endoscopy. A heartburn clinic nurse will pre-screen the patient by phone to determine eligibiity for direct screening.