Taster/Discovery Visit Request

Please tell us...
Please Enter Your Full Name *
Please Enter Your Kid's Name (if requesting on behalf of a child)
Primary Reason For Wanting To Sample Physical Therapy *

I'm new to physical therapy and am not sure what to expect I was let down by another physical therapist in the past and would like to see how good you are 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 for me doing it this way

Where Does It Hurt? *
What Does It STOP You From Doing? *
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 would be the one thing you would like us to achieve for you? *

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