Medical Records

To request the release of information, please print the Authorization for Release of Medical Information form, complete 100% of the information and fax or mail it to DMOS Orthopaedic Centers c/o Medical Records Office. Please send them to the office in which you received care from your respective DMOS surgeon. Records will then be mailed to the appropriate party, or you are welcome to pick them up at our Registration Desk.

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

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