Request To Speak with A Physical Therapist
So that we can meet your SPECIFIC needs, please fill out this 35 second form and show us
EXACTLY how you want us to help you...The more we know, the better we can help...
PS - Your Information Is 100% Safe With Us. We Will NOT Share It With Anyone!
Please Enter Your First Name:
Please Enter Your Child's Full Name (If Requesting on behalf of a child):
Please Enter Your Last Name:
Please Enter Your Ideal Date and Time for the Phone Call:
Primary Reason For Wanting to Speak to a Physical Therapist?
I'm new to physical therapy and am not sure what to expect
I was let down by another physical therapist in the past and would like to see how good you are before I commit
I'm not sure if physical therapy can even help me
I'd like to get a feel for what you can do to help me BEFORE I commit to a full appointment
It's just easier for me doing it this way
I'm Scheduled for surgery and exploring other options.
Where Does It Hurt?
Wrist / Hand
Foot / Ankle
Does Not Hurt
What Does it Stop You From Doing?
What's Your Main Concern That Has You Considering Physical Therapy?
The Pain I am Experiencing
Fear of not being able to keep active
I worry about not knowing what is wrong
I want to avoid painkillers
I am concerned that it is not getting better
Future Ill Health and wanting to prevent it
How Long Have You Suffered Or Worried? *
A Few Days
Too Long (Years)
What would be the one thing you would like us to achieve for you? *
Ease The Pain
Ease The Stiffness
Stay Active and Involved
Avoid Pain Killer Dependency
Find Out What is Wrong
Stay Healthy and get better before it gets worse
Please Enter Your Best Phone Number to Reach You At:
Please Enter Your Email For Confirmation:
Schedule My PT Phone Call