UnityPoint Clinic Urgent Care - West

2255 John F Kennedy Road
Dubuque, IA 52002

Current Estimated Wait:
0 hr 9 min

To register for your maternity and childcare stay at our Family Birthing Suites, please complete the following information and click submit.

Please view our Privacy Policy to learn about the secure electronic handling of your personal information.

Please bring your Insurance Card and Picture ID with you on the day of admission.

After clicking the send button at the bottom of this page, a screen will show confirming that your registration has been received. It will also provide you with next steps.  

Birth Care Pre-Registration

Please complete this form at 18-20 weeks in your pregnancy.

Birth *
Delivery Method
Would you like to receive our birthcare information by mail or email?

Patient Information

Marital Status
Patient Race
Baby Race
Translation/Interpreter Services Needed?
Spiritual needs are important to some patients, would you like us to notify your faith community leader of your admission?

Mailing Address

Employment Status (if applicable)

Emergency Contact Information

Mother's Insurance Information

Mother's Secondary Insurance

Secondary Insurance? (If yes, please complete section)

Baby's Insurance Information

Is the baby's insurance the same as the mother/carrier? *