After you’ve contacted the local office you’d like to visit, you’ll need to fill out the following forms. If you do not wish to download them, we are happy to mail them to your residence or you may fill them out at the office before your scheduled appointment.
Download and complete our patient forms before your first visit to make things easy and organized!
Informed Consent Acknowledgment
Acknowledgment of Privacy Practices
Authorization for Release of Information
Request to Review or Obtain Copies of Protected Health Information
Acknowledgement of Privacy Practices – Spanish
Informed Consent Acknowledgment – Spanish
Acknowledgment of Privacy Practices – Spanish
Insurance Authorization – Spanish
Track your appointments, information and records through our secure patient portal.
Secure online bill pay is available for your convenience.
180 10th St. SE, Suite 201
P.O. Box 70
Le Mars, Iowa 51031
Phone: 712.546.4624
Fax: 712.546.9395
Toll Free: 800.325.1192
Le Mars
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Cherokee
Ida Grove
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Carroll
Denison
Lake City
Sac City
Spirit Lake