First Name *

Last Name *

How Did You Hear About Us? *

Main 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 therapist in the past and would like see if we are a good fit for each other before I commit

I'm NOT sure if Physical Therapy can even help me

I'd like to get a feel for what you can do to help me BEFORE I commit to a full appointment

It's just easier doing it this way

Where Is Your Pain or Stiffness? *

Where Is Your Pain or Stiffness?

What does it STOP you from doing? *

What Is Concerning You Most That Makes You Want To Consider Physical Therapy *

What Is Concerning You Most That Makes You Want To Consider Physical Therapy

How Long Have Your Suffered Or Worried? *

Haven't - this is prevention not cure

1-2 weeks

2-4 weeks

1-3 months

Long enough

Seems like too long (years)

Your Main Goal That You Would Like To Achieve With Us *

Your Main Goal That You Would Like To Achieve With Us

Phone *

Email *