New Patients
NEW PATIENTS
To save time during your initial visit, please fill out the paperwork below and bring it with you to your visit. You can also fill out paperwork online
through our portal and enter client code P1477426/
and get access to your health information. If you have not been given access to our portal, please
call our office and speak to the receptionist.
WEST DES MOINES LOCATION
Westown Medical Plaza
5901 Westown Parkway Suite 250 West Des Moines, Iowa 50266
Phone: (515) 410-9400
Fax: (515) 410-9401
ANKENY LOCATION
800 East 1st Street Suite 2400
Ankeny, IA 50021
Phone: (515) 452-0600
Fax: (515) 452-0606
Patient Forms
- Prior to Your Appointment
- New Patient Insurance
- New Patient Past Medical History
- Release to Insurance
- Acknowledgment of Privacy Rights
- Consent to Treat a Minor
- HIPAA Privacy Rights
- Financial Policy
- No-Show/Missed Appointment Policy
- No-Show/Missed Appointment Policy - ITC & VA
In order to view or print these forms, you will need Adobe Acrobat Reader installed.