Patient Documents & Forms
Sliding Fee Scale Quick Reference Guide
How Peoples Clinic Determines Your Sliding Fee Category
Annual Financial Assistance Application
As your primary health care provider, it is important for us to have access to all your healthcare records in order to provide you with the best quality of care.
Please print this Release of Information Form (ROI) linked above if you need a copy of your medical or dental records. This form must be completed, signed, and dated by the patient, parent, guardian, or legal representative. The request will not be honored if all fields are not completed. See some helpful tips on filling out the form by viewing our example.
If you have any questions regarding this form, call the Medical Records Department at 319-874-3408 to speak with a Health Information Representative.