Request An Appointment

Appointment Type *

Initial Evaluation

Free Screen in Clinic (15 mins.)

Free Call (15 mins.)

First Name *

Last Name *

Email *

Phone *

Nearest TheraFit Rehab *

What services are you interested in?

Physical Therapy

Occupational Therapy

Speech Therapy

Fitness Therapy (self-pay)

Referral Source: How did you first see or hear about TheraFit Rehab? (Helpful but not required.)

Type of Insurance (Required if you selected Initial Evaluation as appointment type; optional for others.)

Primary Complaint or Other Comments:

I confirm I want to receive communications from TheraFit Rehab, and I understand I can adjust my communications preferences anytime.