PATIENT REGISTRATION

Complete the form below or call to schedule 319-246-2006

Patient Registration / Demographics

Demographics

Leave N/A if you do not have one.
Leave N/A if you do not have one.
 

What brought you in today?

 

Side of the body?
Acknowledgements

For our records, please send front and back pictures of your insurance card to our office email: office@teamiowapt.com


CAPTCHA

CONTACT

2400 North Dodge Street, Suite B
Iowa City, IA 52245
Call: 319.246.2006
Fax: 319-483-6919
office@teamiowapt.com