Admissions

Admissions Inquiry Form

The decision to contact a skilled nursing home for yourself or a loved one can be a difficult decision to make. However, we have staff dedicated to making this process as easy as possible.

Contact Morgan Voga at (515) 509-6269 for any admission questions.

If you’d like to start this process, please fill out the information below and we will contact you.

Date of Application(Required)

Name of Applicant(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address(Required)

Email address of applicant or family member for communication purposes

Phone Number(Required)

Phone number of applicant or family member for communication purposes

How did you hear about us?(Required)

CAPTCHA

(515) 509-6269

morgan.voga@bethanylife.org

(515) 733-5293 (fax)

Thank you for reaching out to Bethany Life!

I will be your contact during this process. Once we have your application our business office and clinical staff will look over everything and reach out if they have any questions. We may need additional forms including a PASRR (Pre-Admission Screening and Resident Review required by DHS), a Medication List and History & Physical forms from your primary care provider. We will assist with obtaining this information. Once financially and clinically approved then orders for admit will be requested from your Primary Care Provider. Admission paperwork and releases must be filled out, copies of POA/Living Will obtained and copies of insurance cards will be requested. Again, we are here to help!

Our team will contact you on a day and time for admissions.

"Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand."
– Isaiah 41:10