Eyerly Ball Access Enrollment Form

UnityPoint Clinic - Express

180 Jordan Creek Parkway, Suite 120
West Des Moines, Iowa 50266

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Altoona

2720 8th St. SW
Altoona, Iowa 50009

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Ingersoll

2103 Ingersoll Ave., Ste. 2
Des Moines, Iowa 50312

Closed Patients
Waiting Now

Urgent Care - Ankeny

3625 N. Ankeny Blvd.
Suite E
Ankeny, Iowa 50023

Closed Patients
Waiting Now

Urgent Care - Lakeview

6000 University Avenue
Suite 101
West Des Moines, Iowa 50266

Closed Patients
Waiting Now

Urgent Care - Merle Hay

4020 Merle Hay Road
Suite 100
Des Moines, Iowa 50310

Closed Patients
Waiting Now

Urgent Care - Southglen

6520 SE 14th St.
Des Moines, Iowa 50320

Closed Patients
Waiting Now

Urgent Care - Urbandale

2901 86th Street
Urbandale, Iowa 50322

Closed Patients
Waiting Now

Eyerly Ball Access Enrollment Form



* indicates required fields

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Client Aware they have been referred
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Lives in one of the following counties
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Is the individual currently homicidal or suicidal *
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Are there any concerns regarding staff safety (e.g. violent behavior)
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Client Needs
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Programs Interested In (check all that apply - eligibility requirements may differ from above)
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Has Individual been hospitalized in the past 2 years for Mental Health *
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Has Individual been incarcerated in the past 2 years *