Copy of Request An Appointment First Name * Last Name * Email * Primary reason for wanting to see a Physical Therapist * Please select oneI'm new to Physical Therapy and 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. Tell us what's happening * Please select oneblocked milk ductelbow pain or stiffnessfoot/ankle pain or stiffnessheadachesjaw painknee pain or stiffnesslower back/hip pain or stiffnesslymphedema/swellingmid-back pain or stiffnessneck/shoulder pain or stiffnesspelvic floor issuesprenatal issuespostnatal issuessport injuryvertigo/ dizziness/ or balance disorderweaknesswrist/hand pain or stiffness Submit First Name * Last Name * Primary reason for wanting to see a Physical Therapist * Please select oneI'm new to Physical Therapy and 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. Tell us what's happening * Please select oneblocked milk ductelbow pain or stiffnessfoot/ankle pain or stiffnessheadachesjaw painknee pain or stiffnesslower back/hip pain or stiffnesslymphedema/swellingmid-back pain or stiffnessneck/shoulder pain or stiffnesspelvic floor issuesprenatal issuespostnatal issuessport injuryvertigo/ dizziness/ or balance disorderweaknesswrist/hand pain or stiffness What does it STOP you from doing? * Next Your main concern * Please select onePain you are experiencingWorrying over not knowing what's going onConcerns over no signs of improvementAvoid painkillersNot being able to keep active and do normal activitiesFuture ill health and wanting to prevent itOther How long have you been concerned * Please select onea few days1-2 weeks2-4 weeks1-3 monthsLong EnoughToo Long (Years) What is the main goal you would like us to help you achieve? * Please select oneease painease stiffnessincrease strengthimprove balanceget activestay activeavoid painkiller dependencyavoid surgerydiscover the source of the issuestay healthyget fixed before pain gets worse What do you value when working with a PT? (choose any) - ability to limit the return of pain- access to gym equipment- hands on care- home exercises to speed up recovery- natural treatments- one-on-one care Back Next Anything else we should know to help you? Best Email * Best Phone * Back submit After you press the button, please check your email for a message from Kim Gladfelter with further instructions. All of your details are 100% safe with us.
