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:
Patient Registration Form
Are you a new patient with DMSI? Fell free to save time and download the PDF and complete the form.
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
Locations Near You
Bloomington, IL
Phone: (309) 451-3376
Fax: (309) 452-3376
Canton, IL
Phone: (309) 451-3376
Champaign, IL
Phone: 309-451-3376
ADDRESS: 1 E Main St Champaign, IL 61820
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
Phone: (217) 451-0168
FAX: (309) 452-3376
Peoria, IL
Phone: (309) 451-3376
FAX: (309) 452-3376
Peru, IL
Phone: (815) 842-4000
FAX: (309) 452-3376
Pontiac, IL
Phone: (309) 457-3376
FAX: (309) 452-3376
Princeton, IL
Phone: (309) 451-3376
FAX: (309) 452-3376
Springfield, IL (E. Madison)
Phone: 309-451-3376
Streator, IL
Phone: (309) 457-3376
FAX: (309) 452-3376