Name
*
Primary Reason For Wanting A Physical Therapy Discovery Session?
*
I'm new to physical therapy and not sure what to expect
I was let down by another physical therapist in the past and I would like to see if we are a good fit for each other before I commit
I'm NOT sure physical therapy can help
I'd like to see what physical therapy can do for me before I commit
Where Is Your Pain Or Stiffness?
*
Lower Back
Neck
Shoulder
Arm
Knee
Ankle/Foot
Muscle From Sports Injury
Not Sure
What Does It STOP You From Doing?
*
Back
Next
What Is Concerning You Most?
*
The pain your experiencing
Worrying over not knowing what is wrong
Concerns over no signs of significant improvement
Avoiding pain killers
Staying active
How Long Have You Suffered or Worried?
*
A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Way Too Long (Years)
Main Goal That You Would Like Us To Help You Achieve?
*
Ease Pain
Ease Stiffness
Get Active
Avoid Pain Killers
Find Our What Is Wrong
Back
Next
Please tell us where to contact you with the outcome of the Free Discovery Session application:
Phone Number
*
-
Area Code
Phone Number
Best E-Mail
*
Submit
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