Book a Telehealth Session

Please complete the information below to allow us to set up a consultation with you.

Your Name*
First Last
Email Address*
Phone (optional)
Your Home State*
State
Date of Birth*
Preferred Date*

Specify the date you would prefer to have your appointment. We will confirm availability with you.
Preferred Time*

: HH

MM

Provide an approximate time for this appointment. We will try to fit your request to a 2 hour window around this time.
Terms and Conditions*
- I agree to the terms below
By clicking "I agree to the terms below", I understand that this physical therapy assessment will be conducted by a two way communication telehealth physical therapy platform and that my physical therapist has deemed this type of service appropriate and safe for the condition for which I am currently being treated. I understand that this telehealth service is a HIPAA compliant platform and that all safety and security measures to secure my protected health information have been instituted but I acknowledge the inherent risks of online transmission of data. I also understand that there is a chance that transmission of health information may be disrupted due to technological limitations outside of the telehealth platform