Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Trinity MSG AssociatesIndraneel Chakrabarty, M.D., M.A, A.G.A.F. General & Advanced GastroenterologyDavid Lee, M.D., M.B.A., F.C.C.P. Pulmonologist Sleep Study SpecialistEmanuel Shapera, M.D. Advanced GI Robotic Surgeon Bariatric and Hepatobiliary Surgical OncologyFirst Available for GIAngela Saunders, D.O. General GastroenterologyLocations:TEMECULA 31625 De Portola RD Suite 101 Temecula, CA 92592Referring Physician InformationLayoutReferring Physician’s Name *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDateOffice PhoneOffice FaxPrimary Care PhysicianPatient InformationLayoutPatient’s Name *AddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSexMaleFemaleDate of BirthPhone (Best Contact)LayoutPROCEDURESScreening ColonoscopyColonoscopy DiagnosticEGDEUSRectal EUSERCPCapsuleManometryBravo PHOtherExplanationINSURANCEPrime Care, HemetPrime Care, TemeculaGraybill Medical GroupRegal Medical GroupTri Valley Medical GroupIEHPMedicarePPOHMOSelf PayOtherExplanation Reason for Referral / IndicationsLayoutScreening ColonoscopyWeight LossAbdominal PainCancer Work Up: Colon CancerChange in Bowel HabitsPancreatic CancerConstipationEsophageal CancerDiarrheaGastric CancerGERD/HeartburnGastrointestinal Stromal Tumor (GIST)Hepatitis/CirrhosisLiver TumorJaundicePancreatic CystsMelenaNausea/VomitingRectal BleedingChest ultrasoundLimited Cardiac UltrasoundThoracentesisParacentesisFiberoptic BronchoscopyION Robotic BronchoscopyEndobronchial Ultrasound Guided Lymph Node BiopsyOtherExplanationPhysician Comments: Submit76616 BRAND VALUES Trinity Medical MSG holds dear the following core values:We remain dedicated to embracing the highest levels of patient healthcare.We transcend boundaries by enlisting advanced technology to enhance patient care.We are optimistic, seeing the world for what it is and what it can be.We have initiative to effect meaningful change.We are courageous, embracing the risk of our ambitions.We are visionary, scaling our commitments to a world that needs better gastroenterology care and bold action. You will receive confirmation once the appointment is scheduled. Thank you for referring your patient to Trinity Medical MSG, Inc.