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ROM M GUPTA, MD
DIGESTIVE DISEASES & NUTRITION, LLC

  • (718) 291-0488
  • PATIENT FORMS
  • ONLINE BILL PAY
  • REQUEST AN APPOINTMENT
  • Home
  • Meet Dr. Rom M. Gupta
  • Conditions
    • Heartburn
    • Abdominal Pain / Gas Bloat
    • Constipation / Diarrhea / Irritable Bowel Syndrome (IBS)
    • Hepatitis B & C / Liver Diseases
    • NAFLD (Fatty Liver)
    • Gallbladder
    • Hemorrhoids
    • IBD (Ulcerative Colitis)
    • Other Gastrointestinal Conditions
  • Procedures
    • Colonoscopy
    • Hemorrhoid Therapy
    • Upper Endoscopy
  • Dietary Plans
  • Reviews
  • Contact Us

Patient Forms

Thank you for selecting Digestive Disease & Nutrition for your gastrointestinal care. To schedule an appointment, please call us at (718) 291-0488, or use our online appointment request form.

More information coming soon!

Patient Forms

Thank you for selecting Digestive Disease & Nutrition for your gastrointestinal care. To schedule an appointment, please call us at (718) 291-0488, or use our online appointment request form.

Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.

Please be sure to bring forms with you to your first visit along with any diagnostic films or other test results that may have been ordered or performed by another physician.

Established patients can update forms online through our patient portal. If you need help accessing the portal, please call the office, and we’ll be happy to help.

Downloadable Forms:

  • New Patient Packet
  • Health History

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by viewing the icon below.
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175-61 Hillside Ave, Ste 402
Jamaica Estates, NY, 11432

(718) 291-0488

ROM M GUPTA, MD
DIGESTIVE DISEASES & NUTRITION, LLC

Copyright 2025 · Rom M Gupta, MD - Digestive Diseases & Nutrition, LLC · All Rights Reserved

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Dr. Rom Gupta in Queens, NY,  specializes in treating a variety of gastrointestinal conditions and offers a variety of treatments, services, and procedures such as Upper Endoscopy, Colonoscopy, and Hemorrhoid Therapy.