Medical Records

To request your medical records online, please scroll down and complete the Release of Information online form. If you would prefer to mail or fax the form, please print the Authorization for Release of Medical Information form. Complete the form and mail it to DMOS Orthopaedic Centers c/o Medical Records or fax to 515.224.5337. Fill out the form completely.  It takes 7-10 business days for a request to be processed.

DMOS – Ankeny, Des Moines & West Des Moines

Tel: 515.224.1414, option #6 for Medical Records
Fax: 515.224.5337

  • Step 1: Patient Information

  • Step 2: Record Request

  • Step 3: Types of Records

  • Date range
  • Step 4: Purpose of Release

  • Step 5: Receiving your Records

  • Step 6: Sign and Submit

  • Date Format: MM slash DD slash YYYY
    Enter today's date
    By checking the box, I am authorizing this release.
  • This field is for validation purposes and should be left unchanged.