Thank you for choosing Eastern Iowa Health Center for your health care needs. Below are forms you may need to fill out in order for us to serve you best.

Please call us at (319) 730-7300 with any questions.

• Dental Health Questionnaire
• Dental Center Patient Registration Form
• Annual Financial Assistance Application
• Self-Declaration Form Sliding Fee Discount Program
• Health Records Release of Information
• Consent to Treat Minor in Parental Absence Form