Doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD 2025

Get Form
doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD Preview on Page 1

Here's how it works

01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD with Our Platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields. Fill in your name, identification number, and date of birth accurately.
  3. Specify who is authorized to disclose your medical information by providing their name, address, and phone number.
  4. Indicate who will receive the information by filling out the recipient's details including their name and contact information.
  5. Select the type of medical records you wish to request by checking the appropriate boxes for options like 'Entire medical record' or 'Immunizations'.
  6. State the purpose of your request by selecting from options such as 'Transferring medical care'.
  7. Review the authorization section carefully. Ensure you check 'Yes' or 'No' for any protected information that may be included.
  8. Choose your preferred delivery method for receiving the information, whether by mail, fax, or email.
  9. Finally, sign and date the form at the bottom to complete your authorization.

Start using our platform today to streamline your document editing and signing process for free!

See more doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD versions

We've got more versions of the doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD form. Select the right doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2018 4.9 Satisfied (50 Votes)
2013 4.1 Satisfied (32 Votes)
2010 4 Satisfied (50 Votes)
be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us

Upload your doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD to DocHub (once you’ve created an account for this). If you need to fill out fields in it, use appropriate tools from the upper pane. For example, drop Signature Fields, assign each to specific person, and click on Sign → Request signatures from others. Customize your message for your recipients and click Send Request. You can also send your paperwork by fax or as a Signing link instead of using email (you’ll locate these options by navigating to the Menu → Send)

If you are using Chrome, there are two simple ways to modify your doctor.webmd.compracticedes-moines-universityDes Moines University Clinic in Des Moines, IA - WebMD online. First, go to the DocHub website, add your file, and modify it using our toolbar. You may also set up our Chrome extension and modify any document by dragging and dropping it in your browser tab.