Forms
The following forms are to be completed by every new patient that visits Des Moines Orthopaedic Surgeons. If you have been treated at DMOS in the past but are seeing us for a new condition or it has been more than 6 months since we last treated you, the forms are also necessary.
To save time at your clinic visit please print and complete the following two forms (they cannot be completed online):
| Download Printable Forms in PDF Format |
 General Health History Form* 58KB New Patient Registration Form* 191KB |
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The specific DMOS physician you are treating with may require additional forms to be completed. Those will either be mailed to you to complete prior to your appointment or they will be provided to you when you arrive at your appointment.
A copy of your insurance card will also be necessary at every visit. If your insurance plan requires a physician referral to see a specialist, please make the appropriate arrangements with your primary care physician before your appointment at DMOS.
To make a request for Medical Records/X-Rays/MRI's, etc.
If you are in need of a copy of your medical records, x-rays and/or MRI images from DMOS, please contact the Medical Records Department or your physician's secretary. All requests will require an Authorization to Release of Medical Records Information form completed. We will need 48 hours to fill your request. You are welcome to contact the Medical Records Department if you require additional information and to identify any fees that may apply.
To request release of information please print the Authorization for Release of Medical Information form, complete 100% of the information, and fax or mail it to Des Moines Orthopaedic Surgeons, Medical Records office in which you received your care. Records can be mailed to the appropriate party or you can pick them up at our Registration Desk.
DMOS Medical Records phone/fax numbers:
DMOS - West 515-440-9020/515-440-9021/Fax - 515-224-5153
DMOS - East 515-263-9696/Fax 515-263-0233
DMOS - Carroll 712-792-2093/Fax 877-839-7532
To print a copy of the Authorization for Release of Medical Information form, Click Here.