Online Forms
Save Time, Complete Forms at Home
Please only complete forms if you already have an appointment at our clinic. If you do not have an appointment, please request one here.
We offer our patient forms online so that you can save time at your visit by completing them before you even arrive at our clinic.
Click on the desired form name, then print, fill in, and bring along to your appointment. If you have questions about which forms to complete, please call us at 319-432-0922.
1. New Patient Health History
This form should be completed by all new patients and those seeking a no-cost consultation. Only complete this form after you have confirmed an appointment date at our clinic. Download form.
2. Records Request, Release of Health Information
Complete this form if you wish to have your records sent from another provider to InMotion Pain Solutions, or if you want InMotion Pain Solutions to send your records to another healthcare provider. Download form.