Download Forms

Save time! If you are a new patient with an upcoming appointment and would like to complete the registration process prior to your arrival at our office, download our New Patient Forms:

New Patient Form

Are you a new patient with DMSI? Fell free to save time and download the PDF and complete the form.

Medical Records Release Form

Do you need to get your medical records sent to you or someone? Fill out this form and we can get the process started

Authorization for Release of Confidential Health Information

Do you need to get your medical records sent to you or someone? Fill out this form and we can get the process started

Locatations Near You

Bloomington, IL

Champaign, IL

Charleston, IL

Phone: (217) 234-8000
FAX: (217) 234-8003

ADDRESS: 100 Deerpath Rd
Charleston, IL 61920

Eureka, IL

Phone: (309) 481-3021
FAX: (309) 452-3376

ADDRESS: 101 S. Major St.
Eureka, IL 61530

Mt. Zion, IL

Peoria, IL

Phone: (309) 451-3376
FAX: (309) 452-3376

ADDRESS: 9118 N. Lindbergh Drive
Peoria, IL 61615

Peru, IL

Phone: (815) 842-4000
FAX: (309) 452-3376

ADDRESS: 920 West Street
Suite 216 Peru, IL 61354

Pontiac, IL

Princeton, IL

Springfield, IL (E. Madison)

Streator, IL