Are you the patient listed above? *:

If no, is the patient able to give medical consent? *:

Have you had a colonoscopy before? *:

history of colorectal cancer? *:

Personal History of Polyps? *:

Have you had a positive result from Cologuard or FOBT in the last 6 mos? *:

Are you taking any prescription blood thinners (Warfarin, Plavix, Coumadin, Pradaxa, Effient, Brilinta, Xarelto, Eliquis, Aggrenox or Arixtra)? *:

Have you had a heart attack in the last month? *:

Do you have Hemophilia/bleeding or blood clotting disorder? *:

Are you currently on dialysis? *:

Are you on a transplant list? *:

Are you pregnant? *:

Do you have a colostomy bag? *:

Do you have frequent bleeding? *:

Do you have hidden blood in stool/ Hemoccult+? *:

Are you having unexplained weight loss? *:

Currently experiencing diarrhea, constipation or significant change in bowel habits? *:

Have frequent abdominal pain? *:

Presently have anemia or low blood count? *:

Are you diabetic? *:

If Yes, Pills or Insulin? *:

Do you have any physical limitations? *:

Have you had issues with cleaning out for a colonoscopy in the past? *:

Have you been diagnosed with sleep apnea? *:

Do you have Hepatitis B, Hepatitis C, or HIV? *:

Have you had any significant heart disease, such as congestive heart failure or recent coronary artery disease or have you had heart valve replacement or heart surgery? *:

TIA/stroke in the last month? *:

Seizure in the last 6 months? *:

Do you have renal disease? *:

If yes, are you on either? Hemodialysis or Peritoneal Dialysis:

Do you have COPD or any lung problems? *:

Do you have a pacemaker? *:

If yes, is it a defibrillator?: