Patient History Form

Medical History

Welcome!  We are glad to see that you got our note about gathering your medical history.  We ask this of all patients coming in for their first visit related to a new injury.  Having a complete Medical History is critical information for your doctor to assess your condition correctly.

Just to let you know, there is no save feature, so you will want to finish it once you start.  It will be helpful to gather the following information beforehand:

  • Medication bottles or your medication list
  • Previous medical records


Getting this done as soon as possible will mean you will not have to rush to our office and arrive 30 minutes early to complete on paper.

Demographics and Insurance

Lastly, be on the lookout for an email/text two days before your visit.  This will be an opportunity for you to review and update your demographic and insurance information.

We look forward to seeing you at your upcoming visit.  Thank you for choosing Iowa Ortho.