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Patient Education & Forms

Patient Forms

Authorization for Release of Medical Records

Moderna Vaccine Fact Sheet


Information on common conditions:

Listed below are some of the most commonly seen diagnoses family physicians see patients for.  We have attached a link so you can read more information about these diagnoses.   Once you are on the website, you may research other diagnoses that are not listed below. 

Educational Articles

Ready to be a Quitter? Smoking , that is……

Quitting smoking is not easy, but you can do it. To have the best chance to quit smoking and staying quit, you need to know what you’re up against, what your options are, and where to go for help. Your family doctor is here to assist you with information, support and other means to help you win the battle against tobacco. Contact us for an appointment with your primary care provider to get started on the road to becoming a “Quitter”. Below are some resources for your information on the benefits and the “How To” quit smoking. 

Northeast Iowa Family Practice Center

Griffin Hickey, MPH, Smoking Cessation Coaching

Call 319-272-2112 for an appointment.

American Lung Association

Toll-free number: 1-800-548-8252 

Web site:

National Cancer Institute

Web site:

Toll-free tobacco line: 1-877-448-7848

Tobacco quit line: 1-800-784-8669 (1-800-QUIT-NOW)

Direct tobacco Web site:


Web site:


Chronic Obstructive Pulmonary Disease

COPD( Chronic Obstructive Pulmonary Disease) is a serious condition that is the 4th leading cause of death in the world. Here is a link to a very informative presentation on this condition that we recommend viewing for those that are interested. The cause of COPD is primarily from cigarette smoking over time and it is usually progressive. The primary symptoms are a productive cough of sputum, shortness of breath, and wheezing. Measurement of lung capacity is the primary method of making the diagnosis. Smoking cessation, if applicable, is essential in risk reduction. Medications can help manage the disease and are primarily provided through various inhalers, although some oral medications also help. Early treatment of respiratory infections is also important, as is a pneumonia prevention vaccine and a yearly influenza vaccination. Pulmonary rehabilitation can help advanced cases, when oxygen may also be needed. Stay informed and be healthy.


The effects of alcoholism are common, expensive and serious. 16% of patients seeing primary care physicians have or have had problems with alcohol. In the US, alcohol is the 3rd leading cause of preventable deaths (85,000) at a cost of $185 billion. 7% of the North America is linked to alcohol and accounts for the following: Cirrhosis 32%; MVA 20%; Mouth cancers 19%; esophageal cancer 29%; Liver Cancer 25%; Breast cancer 7%; Homicide 24%; Suicide 11%; and Hemorrhagic Stroke 10%. Fetal alcohol syndrome is the leading known cause of mental retardation. In addition, binge drinking (5 or more drinks in men and 4 or more drinks in women) increases the risk of contracting sexual transmitted disease and pregnancy. Chronic use of alcohol actually causes physical changes at the cellular level, cerebellar degeneration, Wernicke-Korsadoff syndrome, tremors hallucinations, delirium tremens, and withdrawal seizures. When alcohol is combined with tobacco and/or other drugs, the effects of alcohol are magnified. For more information, check out the, or consult your primary care physician.

Mobile Phone Apps

We are excited to share with you some of the quality mobile health apps available for smartphones and tablets.   When you download these applications, you are on your way to tracking your own way to better health! 

52 Weeks for Women's Health

By the National Institutes of Health for iPhones and Androids

This mobile app is for anyone interested in educating themselves more on women's health from 'eye health' or 'pregnancy'.  Fifty two health topics offer lifestyle tips applicable to that subject and you can quickly make a list of your favorite tips for quick references.  This app also gives you the ability to track your own personal health information such as medications, allergies and wellbeing. 

BMI Calculator

By the National Institute of Health for iPhones

This is the #1 tool on Google and receives 1.6 million visitors a month to the National Heart, Lung and Blood Institute's BMI calculator app.  BMI(Body Mass Indicator) is a reliable tool for total body fat, which relates to the risks for diseases and death.  


By the National Library of Medicine for iPhones, iPod touch and iPads

This cool, educational app offers 2D and 3D images  describing the stages of embryo development.  Various information on pregnancy and stages of embryo growth along with videos on how fertilization occurs within the body are included in this app.  You can use this mobile app to follow your pregnancy, a friend's or that of a family member's pregnancy.    


By Center for Disease Control and Prevention for iPhones

This health app allows you to track flu-like activity levels across the U.S.  The CDC is required to track such symptoms as they are reported  to health care providers across the country.  With this current information, you can use this app to display reports in your local area and compare them to period of high and low flu risks.    

Health Hotlines

By National Library of Medicine for iPhones, iPods, and iPads

This is a community service mobile app to help the public locate health-related information.  It is a directory of over 9,000 organizations with toll-free telephone numbers.  Subject matters include AIDS, cancer, other diseases/disorders, maternal & child health, aging, substance abuse, disabilities and mental health.  The organizations fall into many categories such as:  government agencies, information & referral centers, professional societies, support groups and volunteer organizations. 

NCI QuitPal

By National Cancer Institute for iPhones, iPod Touch and iPad

This mobile app was designed to help you become smoke free!  It offers proven strategies/tools to help assist you in giving up smoking. Features include:  calendar functions to set a quit date, financial goals by date and reminders; tracking daily smoking habits with easy to use log; graphic features tracking money you've saved and number of packs you have not smoked; health milestone alerts and craving tips to stay motivated; Facebook/Twitter integration so friends can be updated on your milestones; Video diary features and ability to receive personalized video messages from loved ones. 


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