Request for Physical Therapy Appointment

New Patients

  • Please complete the request for appointment below for the location of your choice.
  • A staff member will contact you within 24-48 hours to schedule an appointment.
  • Once you have completed the request for appointment please visit our New Patient Registration Forms page to download and fill out our intake paperwork.

Existing Patients

  • Please contact the clinic directly by phone to schedule an appointment.

First Name (required)

Last Name (required)

Email (required)

Phone Number (required)

Zip Code (required)

Do you have a physical therapy prescription from a doctor? (required)
YesNo

Are you 18 years or older? (required)
YesNo

Location (required)

Message/Best Time and Day to Contact

Other than a referring doctor, how did you hear about us? Please specify the name of the individual, event, organization or group. (required)

By clicking this box you agree to receive email communication from Community Rehab Physical Therapy
I agree