Medical Record Forms

Consent to Release Medical Information Form

This form gives permission for Iowa Radiology to send your medical records to another doctor, hospital, or healthcare facility. It ensures your information can be shared with providers involved in your care or ongoing treatment.

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Consent to Release Medical Information Form

Medical Records to Share

This form allows you to request a copy of your medical records for your own personal use. You can choose to have the records mailed to you or made available for pickup, depending on your preference.

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Medical Records to Self Form

As a patient of Iowa Radiology, you are entitled under federal law to request your personal protected health information for yourself or provided to another individual. Please complete this form and submit it to or by fax at (515) 226-9812 along with a copy of a valid, state-issued photo ID. Once received, the information will be used to verify your identity and your request will be processed.

By sending this information you understand that any information sent by email is sent uncrypted, unsecured and accept those risks.