Peoples Community Health Clinic

  • As your health home, 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 and fill out the Release of Information Form (ROI) if you need a copy of your medical or dental records. 
  • The ROI must be filled out completely.  The ROI must be signed and dated by the patient, parent, guardian or legal representative. 
  • The request will not be honored if all required fields are not completed.  Please see below for an example of how to fill out the form. 
  • If you have further questions regarding this form, please call the Medical Records Department at (319) 272-4409 and speak with a Health Information Representative.

Patient Forms