Robotic Surgery Consult | UnityPoint Health Cedar Rapids

Urgent Care - Anamosa

Closed Patients
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Urgent Care - Hiawatha

00 Patients
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Urgent Care - Marion

03 Patients
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Urgent Care - Westside

04 Patients
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Virtual Care - Receive Care Now

X Wait Times
UnityPoint Health - St. Luke's Hospital

Robotic Surgery Consult Form

If you think that you may be a candidate for robotic surgery, a specialist is prepared to help you.  Please fill out this form and we will contact you to discuss your case.  The more complete this form is filled out the better we can understand your individual case.

* required info

Patient Information

Marital Status
Translation/Interpreter Services Needed?


Employment Status (if applicable)

Emergency Contact Information

Insurance Information

Accident Related?
If yes, is this Workers comp?
Primary Insurance Company *
Secondary Insurance? (If yes, please complete section)

Other Information

Spiritual needs are important to some patients, would you like us to notify your Pastor of your admission?