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Transfer Request - Elevate Healthcare

Please complete the form below and someone from our team will reach out to you and help start the transfer process! You can also just come into the clinic as we accept walk-in intakes and transfers.

Monday-Friday 5am-12pm
3595 E. Fountain Blvd #245, Colorado Springs, CO 80910
719-696-9027 extension 200.

We are here to serve and look forward to having you!
Name(Required.)
Date of Birth(Required.)
Phone number/email we can call you at to schedule your transfer.(Required.)
Current Clinic(Required.)
Reason for transfer request
Name of clinic contact who can help us arrange your transfer, if known.
How many take-home doses do you currently have, as of today? (We can still do your intake if you have doses)
What’s your current take-home schedule?
What’s your intake availability?
Anything else we need to know?