Midwest Oral & Facial Surgery, PC
Oral Surgery
West Des Moines, IA
(515) 221-0807
  • HOME
  • Patient Information
    • Introduction
    • First Visit
    • Scheduling
    • Financial Policy
    • Insurance
    • Online Videos
    • Patient Registration
  • Procedures
    • Dental Implants
    • Bone Grafting
    • Wisdom Teeth
    • Facial Trauma
    • Oral Pathology
  • Meet Us
    • Meet Dr. Lemon
    • Meet the Staff
  • Surgical Instructions
    • Before Anesthesia
    • Dental Implant Surgery
    • Wisdom Tooth Removal
    • Extractions
    • Multiple Extractions
  • Referring Doctors
    • Referral Form
    • Links of Interest
  • Contact Us
    • Contact Information / Office Map

Patient Information

  • Introduction
  • First Visit
  • Scheduling
  • Financial Policy
  • Insurance
  • Online Videos
  • Patient Registration

Patient Registration

You may download and bring the following four forms with you to your appointment. In addition to your paperwork, please bring your insurance information, x-ray and referral from your dentist and a list of any current medications you are taking.
 
Please click on the links below to download and print our office forms:
  • Patient Information
  • Patient Health History Form
  • HIPAA Privacy Policy
  • Financial Policy

Technical Note:

PC Users
Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in
from Adobe's web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.

Mac Users
You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe's web site.

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Serving The Following Iowa Cities:
Des Moines • Waukee • Altoona • Ankeny • Urbandale


Address: 1225 Jordan Creek Pkwy, Suite 120 • West Des Moines, IA 50266 • Phone: (515) 221-0807


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