Patient Forms

Patient Forms

To make your visit as easy as possible, we recommend that you fill out patient forms prior to your appointment. You may download and print them by clicking on the links below.

Pre-Registration

To further assist us with our registration process, please download and complete this form if you would like to pre-register as a new patient at Iowa Specialty Hospital and bring it with you to your first appointment.

 

Pre-Registration Form

 

Please download and complete this form if you are a patient of Iowa Specialty Hospitals & Clinics in Clarion, Belmond, Hampton, or other clinics.

 

Release of Health Information

 

Please download and complete this form if you are a patient of Iowa Weight Loss Specialists or Iowa Specialty Surgeons.

 

Release of Health Information

 

Please download and complete this form if you would like to pre-register for Counseling & Therapy Services and bring it with you to your first appointment.

 

Counseling & Therapy Services Patient Form

 

Durable Power of Attorney and Living Will

Please download this form if you wish to complete the paperwork for Durable Power of Attorney AND a Living Will.

 

Durable Power of Attorney and Living Will Form

 

Please download this form if you wish to complete the paperwork for a Living Will ONLY.

 

Living Will Form Only

 

 

Belmond Campus
403 1st Street SE
Belmond, Iowa 50421
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Phone: (641) 444-3500
Toll Free: (844) 474-4321
Clarion Campus
1316 South Main Street
Clarion, Iowa 50525
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Phone: (515) 532-2811
Toll Free: (844) 474-4321
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