Appointment Request
Thank you for your interest in Diligence Physical Therapy and Wellness! We are so excited for the opportunity to help you meet your goals. Please fill out the form below. We will contact you as soon as possible to learn more about your needs and how we can help! We look forward to working with you!
Full Name
*
Full Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What time of day is best to give you a call to discuss more about your goals? This call usually lasts between 10-15 minutes.
*
Mornings
Afternoons
Evenings
How quickly are you hoping to schedule your appointment?
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Same day
Next day
Same week
Within 2 weeks
Do you prefer telehealth or a in-home visit? (Please note in-home visits are ONLY available in Mesa, Chandler, Gilbert, and Tempe, AZ) All other appointment requests much be telehealth.
Telehealth
In-home (Mesa)
In-home (Chandler)
In-home (Gilbert)
In-home (Tempe)
How did you hear about us?
*
Submit
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