Kidney Transplant Patient Referral
Patients may be referred to the Iowa Methodist Transplant Center for evaluation by their nephrologist or dialysis unit, or they may contact the Transplant Center directly (self-referral).
To begin the referral process, please complete the referral form and fax it to the Transplant Center at (515) 241-4100 or send to UPH_Transplant@unitypoint.org.
Kidney Transplant Referral Form
Before an evaluation will be scheduled, the following forms must be completed and sent back to the Transplant Center.
Authorization for Release of Health Information
Dental Clearance Form
Dental Clearance Form (Spanish)
Informed Consent for Kidney Transplant Recipient
Informed Consent for Kidney Transplant Recipient (Spanish)
Health History Form
If Durable Power of Attorney for Health Care, Bring to Evaluation