Essential Physical Therapy and Wellness -

Arrange Your Free (15 Minutes) Telephone Consultation With A Physical Therapist

We're Happy To Chat With You And Answer Any Questions That You May Have. So That We Can Serve Your SPECIFIC Needs, Please Fill Out This Quick & Easy Form And Tell Us EXACTLY How You Want Us To Help YOU. The more we know about you, the better we can help you...

First Name*

Last Name*

Primary Reason for Wanting to Speak With a Specialist

I'm new to physical therapy and am not sure what to expect

I was let down by another healthcare provider in the past & 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?*

If Other Please Describe Here (optional):

How Long Have You Struggled with This Problem?*

I haven't - This is for prevention (not cure)

A Few Days

1-2 Weeks

2-4 Weeks

1-3 Months

Long Enough (4+ months)

Seems Like Too Long (Years)

What specifically does it interfere with or stop you from doing?*

What Concerns You The Most That Makes You Want To Consider Physical Therapy?*

The #1 Thing You Would Like to Achieve From Physical Therapy*

Best Time for a Call Back

During the day

After 5pm

Anytime

So that we can reach out to you to schedule your Complimentary Telephone Consultation, please tell us:

Phone*

Email*