Getting Ready

The following new patient and procedural preparation forms can be downloaded to your computer and printed at home for your convenience. By filling out these forms prior to your appointment, you will save significant time during your visit to Dr. Sameer Islam's office. If you have any questions when filling out these forms, please do the best you can, and our staff will assist you with any questions on the day of your visit. 

New Patient Forms

Directions To Dr Islam's Office

New Patient Registration Pack English

New Patient Registration Pack Spanish

Pns Payment Agreement

Release Of Medical Records

Important Information on Diet and Medications

What can I eat on a clear liquid diet? Can I take my daily medications? These are two common questions our patients ask us before a procedure. Dr. Islam has prepared this guide to help you get ready for your procedure. Please read carefully.

Medication and Clear Liquid Diet Guide


The procedural preparation forms will give you a detailed description of what you need to do during the 24-hour period before the procedure. Please use these as a guide, and contact Dr. Islam’s office at (806) 761-0747 or after hours at (806)-775-8200 and ask for the with any questions.

Please find the appropriate prep for your procedure. Different procedures and circumstances can alter which prep has been prescribed for you. Follow the instructions carefully.

Dulcolax And Miralax For Colonoscopy

Golightly Preparation For Colonoscopy

Prepopik Preparation For Colonoscopy

Miralax Gatorade Preparation For Colonoscopy

Movi Prep Preparation For Colonoscopy

Preparation For Upper Endoscopy

Preparation For Capsule Endoscopy

Preparation For Urea Breath Test

Preparation For Your Procedure - General

Additional Endoscopy Information

Directions To Endoscopy Center

Endoscopy Pre Anesthesia Worksheet