COVID-19 Fund Request Form

UnityPoint Clinic - Express (Jordan Creek)

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

Closed Patients
Waiting Now

UnityPoint Clinic - Express (Waukee)

950 E. Hickman Road
Waukee, Iowa 50263

Closed Patients
Waiting Now

UnityPoint Clinic Adult Respiratory Illness

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

Closed Patients
Waiting Now

UnityPoint Clinic Urgent Care - Altoona

2720 8th St. SW
Altoona, Iowa 50009

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

Request Form for COVID-19 Crisis Fund

We know all UnityPoint Health team members are going above and beyond during the COVID-19 crisis every single day. Our COVID-19 Crisis Fund has been created to help support you during this time. **The COVID-19 Crisis Fund is for UnityPoint Health - Central Iowa Employees only. 

All requests to utilize this fund should be submitted through a manager by filling out the below form. Decisions will be made by administration. All requests should be submitted by Thursday of the week for review. Requests will be reviewed on a regular basis. You should expect to hear back in 7 days. 

The team will work diligently to fulfill as many requests as possible, but funds are limited and it is possible not all requests will be fulfilled. Thank you! 

* Designates mandatory field.






1: Full Name*
2: Preferred Phone*
3: E-mail*
4: Department*
5: Campus*
6: Supervisor/Manager*
7: Main Contact for Information/Implementation (if different than requestor)*
8: Routing code or cost center number*
9: What is the need for request?*
10: Who is the request for/who will benefit from fund? (employees, patient, family)
11: Campus(s) impacted
12: Timeline for fulfillment*
13: Please select from one of the three categories below. *
14: Estimated cost (if known)