Please fill out the following form and we will contact you within two business days.

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This electronic form collects the personal information you provide through unsecured e-mail. The Patient Education Institute will NOT, AT ANY TIME, give any of the information you provide to any third party. The information you provide will go into a secure database accessible with passwords to select employees of The Patient Education Institute. We will review your request and contact you within 2 business days. We will keep the information you provide in this form until you submit a request for the record to be deleted. To submit a request to delete your record from our database, please use our Contact Us form with "Please remove my records." in the comment section.

The Patient Education Institute's privacy statements are listed under two permanent links on each page: "Help" and "Terms" at the bottom of the screen.

Our mailing address is 2000 James Street, Suite 219, Coralville, IA 52241.