how to work with us virtually
Thank you for your request to book an appointment. In order to best schedule you, please tell us…
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What are you dealing with?
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Pain
Leakage
Constipation or other bowel issue
Pregnancy concern
Birth Healing concern
Somethings not working right
I'd rather not say
Other
What Does It STOP You From Doing?
What Is Concerning You The Most?
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The pain I have
This is embarrassing
How this is affecting my workout performance or activity level
Not knowing what's wrong
This is affecting my sex life
Want to avoid surgery or medications
No signs of improvement yet
Fear that my condition may get worse
Other
How Long Have You Suffered Or Worried?
A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Too Long (Years)
What Is Your Insurance Coverage? (for virtual PT sessions only)
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Blue Cross Blue Shield
Self-Pay
Medicare B
Medicare Advantage
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How Important Is It That You Use Your Insurance For This?
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Essential-if I can't use my insurance I'm not interested
It's important but not a game-changer
Doesn't matter, I'll do anything to get better!
Not applicable to me, I'm self-pay
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Best Time for an appointment:
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