Medical Records

To request the release of information online please scroll down and complete the online form. If you would prefer to mail, fax or email, please print the Authorization for Release of Medical Information form, complete the form and fax or mail it to DMOS Orthopaedic Centers c/o Medical Records Office. Your records will then be mailed or faxed to the appropriate party, or you are welcome to pick them up at our Registration Desk at one of our 3 locations.

DMOS Medical Records phone and fax numbers:

DMOS – Ankeny, Des Moines & West Des Moines 
Tel: 515-440-9020
Tel: 515-440-9021
Fax: 515-224-5337

For electronic submission please complete and submit the form below.

Medical Information Release Authorization

Authorization for Release of Medical Information
  • 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.