Appointment Request

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Appointment Request

Submit your request for an appointment here.

Full Name *

Contact Email *

Phone number *

Appointment Type *

Physical Therapy & Preventative Wellness: Treatment & self-management training, general preventative health & maintenance or pain management

Massage Therapy: Hands on massage treatment for relaxation or temporary pain relief by licensed massage therapists

Pelvic Floor PT: Treatment & self-management training for pelvic floor specific difficulties (pain or dysfunction related to pee, poop, or sex)

Virtual Visits: Meet via Zoom to discuss aches, pains, fitness goals, therapeutic exercise, general wellness, training plans and more from the comfort of home

Consultation: Ask health and wellness questions without need of an exam or formal plan of care via phone, Zoom, or in-person

Do you have a preferred clinician? *

Provider name, Certification(s) (Areas of Specialization)

Kelly Clark, Doctor of Physical Therapy, Massage Therapist (Ortho, Chronic Pain, Massage Therapy, Virtual Consultation, Preventative Wellness PT, House Calls)

Ali Van Doren, Doctor of Physical Therapy (Ortho, Chronic Pain, & Pelvic Floor PT, House Calls)

Beth Willis, Massage Therapist

First available

Requested Date

Tell us the best date for you, and we will contact you within one business day to confirm for an available appointment date and time. Leave blank to request an appointment as soon as possible.

YYYY

Preferred mode of contact *

Would you like to confirm your appointment via telephone call, email, or text?

Phone

Text

Reason for visit / more information

Optional: Say as much as you would like about why you are booking a visit with Patient PT.

Submit

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