Apply For A Test Drive Session
A Test Drive Session is made for those who are unsure if Physical Therapy is right for them or need to gain a little more trust of me before committing to treatment. Please fill out the form below. We will be in touch with you shortly to schedule a time to help you discover more about how I can best help you. There is no obligation and no commitment needed to book an appointment following this session.
Name
*
First Name
Last Name
What is the primary reason for wanting to try Physical Therapy?
*
I am new to Physical Therapy and not sure what to expect
I was let down by another Physical Therapist or Health Care Provider in the past and would like to see how good you are before I commit
I am not sure if Physical Therapy can even help me
I would like to get a feel for what you can do to help me BEFORE I commit to a full appointment
My health insurance let me down - this way confirms that I will not be going to left feeling the same way
It is just easier for me doing it this way
Which location do you prefer?
*
Your Home
Outside on your property (weather permitting)
Your Office
Another Authorized Location
Where Does It Hurt?
*
Back
Neck
Shoulder
Elbow
Wrist
Hip
Knee
Ankle
Foot
Jaw
What does it STOP you from doing?
*
Back
Next
What is concerning you most that makes you want to consider Physical Therapy?
*
Dependency on painkillers
Not knowing what is wrong
Fear of losing mobility or independence
The risk of needing dangerous surgery
Having to give up your sport or recreational activity
How long have you suffered or worried?
*
Haven't - this is prevention
A few days
1-2 Weeks
2-4 Weeks
1-3 Months
4-6 Months
Long Enough
Too Long (Years)
What would be one thing your would like us to achieve for you?
*
Ease pain
Ease stiffness
Get Active
Stay Active
Avoid painkiller Dependency
Find out what is wrong
Stay healthy and get fixed BEFORE the pain gets worse
Back
Next
Please tell us where to contact you with the outcome of the Low Cost Test Drive Session
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Submit
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