Request an LGBTQ Appointment at UnityPoint Clinic

UnityPoint Clinic Urgent Care – North Crossing

Closed Patients
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UnityPoint Clinic Urgent Care – San Marnan

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Urgent Care - United Medical Park

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Urgent Care – Prairie Parkway

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Request an Appointment

Compassionate health care in a comfortable environment is our goal. 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.

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.
















Preferred Name:*Legal First Name: *Legal Last Name: *Date of brith (MM/DD/YYYY): *Pronouns: Preferred Provider:Preferred Appointment Date (MM/DD):Appointments available between 5-7 p.m. on the first and third Wednesday of each monthEmail:*Phone Number: