Infusionsoft Tags
Please tell us...
First Name
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Last Name
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Are you looking for a phone call or virtual discovery session via Zoom?
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Please call me!
I would like to visit via Zoom.
Primary Reason For Wanting To Speak With A Specialist
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I'm not sure if physical therapy can even help me
I'm new to physical therapy and am not sure what to expect
I'd like to get a feel for what you can do to help me BEFORE I commit to a full appointment
I was let down by another physical therapist in the past and would like to see how good you are before I commit
It's just easier for me doing it this way
Where Does It Hurt?
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Please select one
Back
Knee
Shoulder/Neck
Sports or Exercise Injury
Foot/Ankle
Wrist/Hand
Elbow
Not Sure Where It's Coming From
What Does It STOP You From Doing?
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What's Your Main Concern That Has You Considering Physical Therapy?
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Please select one
The pain you are experiencing
Fear of not being able to keep active/involved in sporting activity
Worry about not knowing what's wrong
Want to avoid painkillers
Concern at no signs of improvement
Future ill health (and wanting to prevent it)
How Long Have You Suffered Or Worried?
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A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Too Long (Years)
What would be the one thing you would like us to achieve for you?
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Ease pain
Ease stiffness
Stay active or involved in sporting activity
Avoid painkiller dependency
Find out what's wrong
Stay healthy and get better before the pain gets worse
Back
Next
So we can arrange this Complimentary Discovery Session, please tell us:
Best Phone Number
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Best E-mail
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Please verify that you are human
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