Intake Forms

» Intake Forms

FYZICAL Clive looks forward to having you join our host of satisfied clients. Without you there can be no triumph. Because physical therapy without the client is intent without involvement. However inspired, it is like rain without water, only a hope. Because you Love Your Life, your independence, your day… we exist.

We look forward to welcoming you to our state-of-the-art facility and providing you the best physical therapy. To schedule an appointment, please call us at (515) 985-7530.

Once you have made your initial appointment, you may pre-register online by completing the interactive forms below, or you may download and print the forms, fill them out and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the registration process.

If you are coming for dizziness/imbalance: If you are coming for orthopedic issues:
Forms to print and fill out by hand: Forms to print and fill out by hand:
Dizziness/Imbalance Intake Forms Orthopedic Intake Forms
Forms to fill out electronically:
(send in secure email to
Forms to fill out electronically: 
send in secure email to
Dizziness/Imbalance Intake Form - Fillable Orthopedic Intake Forms - Fillable
Spanish Forms: Spanish Forms:
Dizziness/Imbalance Intake Forms - Spanish Orthopedic Intake Forms - Spanish

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