Celebrating 20 Years in Business!
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Patient Info / Forms

We are here to help you enjoy your life, pain-free! To make a convenient appointment, simply call us today at 515-270-0303 (Johnston clinic) or 515-964-8885 (Ankeny clinic). Our practice is dedicated to helping our patients identify the cause of their pain and creating a custom treatment program that will allow them to return to normal activities pain-free.

Patient Forms

At Elevate Physical Therapy & Sports Medicine, we want to maximize your time with us. Prior to your first visit, please download and print out the forms below, and bring them with you to your first visit, along with your insurance information and photo ID. If you are unable to complete these intake forms prior to your visit, please plan to arrive 20 minutes early to your initial evaluation to allow yourself time to fill these forms out.

Before Your First Visit

  • Make a list of questions that you have to discuss on your first visit.
  • List signs and symptoms that can be of importance to the therapist.
  • Have in writing key past medical history, previous treatments, current medications, and other important information.
  • Please call our office to verify your insurance benefits.
  • Arrive 20 minutes early for your first appointment if you need to fill out intake forms prior to your evaluation.
  • Bring with you a copy of your insurance card and a photo ID.

What to Expect on Your First Visit

  • You will register with our friendly front office staff. They will help you navigate the insurance process and treatment program so you can focus on your recovery.
  • You will meet with your physical therapist for the initial evaluation.
  • During the evaluation, your therapist will ask questions about your medical history, current pain, or injury. Open communication helps us understand your problem.
  • Your movement, strength, coordination, and much more will be evaluated. Our purpose is to help you, so please ensure you communicate to your therapist if anything is hurting or bothering you during the examination.
  • Your therapist will recommend and prepare a course of treatments to ensure the quickest recovery and the best results. Your therapist will discuss the recommendations with you.
  • There will be some treatments performed the first day to get you started on your road to recovery. However, during the next visit, you will get into the full swing of your treatment plan.
  • You will schedule your series of visits with the front desk. The amount of therapy needed will be discussed with you, depending on the recommendations of your therapist. We offer many convenient appointment times, however, prime times can become busy, so it is best to book ahead as much as possible.
  • Your therapist will write up their findings and treatment plan to submit to your referring physician or another medical professional who you choose.
  • If you have any questions at any time, please don’t hesitate to call. We want to ensure your satisfaction and full recovery.

Medical Records

How to Request Your Elevate Physical Therapy Medical Records

To request your physical therapy medical records, please complete this medical release form and send it back to our office.

If the patient is a minor (less than 18 years of age), a parent or legal guardian must sign the form. Records may be requested via email, fax or picked up in the clinic. Please note all requests from patients to direct records to a third party must be in writing and signed by the patient/patient representative.

When requesting records, please be sure to include the following:

  • Patient-identifying information
  • What information should be sent (ex: evaluation, past medical history, appointments, treatments, correspondence, or all records)
  • Who should receive the records
  • Date of request
  • Signature

Delivery options:

  • Electronically, via a secured/unsecured provided email address. (Note: If using an unsecured email address, there may be some level of risk that the protected health information (PHI) in the email could be read by a third party.)
  • Paper mailed to the address specified in your request.
  • Faxed, faxed to the number specified in your request.
  • Arranged pick up. If you choose to pick up your medical records, please bring photo identification with you.