The staff at Unified Therapy Services would like to take this opportunity to welcome you to our clinic!
Below you will find various forms. In completing these forms, you will assist us by providing important information the staff will utilize for maximum treatment results. Either drop them off prior to the scheduled evaluation appointment or bring them with you at that time.
If it applies to you or your family, you may be asked to read or complete one or more of the following:
The required Unified Therapy Services forms are designed in compliance with patient privacy and confidentiality
guidelines established by the federal government.
New Patient & Clinic Forms
Pediatric Focused Outpatient Clinic / 4121 Pennsylvania Ave / Dubuque, IA 52002 / Phone 563-583-4003 / Fax 563-583-4737
Check out our Adult Clinic!
Pediatric Focused Outpatient Clinic
4121 Pennsylvania Ave
Dubuque, IA 52002
Monday - Thursday: 8:00 am - 6:00 pm
Friday: 8:00 am - 12:30 pm