Request an Appointment | LGBTQ Clinic
Compassionate health care in a comfortable environment is our goal. Visiting a health care provider can be stressful for anyone, but for some of us, that feeling can be magnified by concerns about discrimination or being misunderstood. UnityPoint Clinic works to provide affirming health and wellness services for our lesbian, gay, bisexual, queer, trans, questioning and non-binary community so you can be treated well and stay well.
To request an appointment, please fill out this form and a representative from our team will contact you within three (3) business days or sooner. Appointments are available between 5:30 -7:30 p.m. on the second Tuesday of each month.
Notice: Please do not use this form for urgent medical issues, same-day appointments or appointment cancellations. If this is a medical emergency, please call 9-1-1.
If this is submitted prior to our opening date, April 9, 2019, appointment requests will be attended to by our team near or after April 9. Thank you in advance for understanding.
*Preferred Name: *Legal First Name: *Legal Last Name:*Date of birth: (MM/DD/YYYY)Pronouns:Preferred Provider:Zip Code: *Phone Number:*Reason for Appointment: (If you are looking to establish care with our clinic, please write "establish care", if there is a specific reason, please provide details so we can best assist you and place you with a provider to fit your needs.)Anything we should know to best care for you:How did you hear about us?