Arrange Your Free (15 Minute) Telephone Consultation With A Physical Therapist So That We Can Meet Your SPECIFIC Needs, Please Fill Out This 35 Seconds Form And Show Us EXACTLY How You Want Us To Help YOU… The more we know about you, the better we can help you… Step 1 of 3 33% Please Enter Your First Name*Please Enter Your Child's Name & AgePrimary Reason For Wanting To Speak With a Specialist*I'm want some tips and advice I can start with right awayI would love to know how long it might take to see some improvementI am not sure If you can help me and would like to speak with a PT to decideWhich Do You Have The Most Difficulty Or Frustration With?*Limited current therapy timeSlow to little progress with current interventionsRequiring assistance for all tasks What Does This STOP You Or Your Child From Doing?*What Concerns You The Most?*Losing mobility or independenceRisk of facing dangerous surgery or more medicationsMissing out on everyday activitiesConcern at no signs of improvement with current therapyNot reaching full potential or best quality of lifeHow Long Have You Been Looking Into Your Therapy Options?*A Few Days1-2 Weeks2-4 Weeks1-3 MonthsLong EnoughWay too Long (Years)Your Main Goal That You Would Like To Achieve With Us* So we can get back to you quickly with more information about the service you have requested back to you, please leave us:Phone*Email* Best Time For A Call Back*MorningAfternoonAfter 5pmAny time This iframe contains the logic required to handle Ajax powered Gravity Forms.
