Home Exercise Package
During this time of being home bound we wanted to give you more access to home exercise equipment.  (minimum purchase of 2 or more on all bands and ice packs).  Please fill out the questions below, and make your equipment purchase choices.  Complete all required fields, then follow the payment instructions below, and submit this form.
We will deliver your purchase no earlier than 2 business days from your order date, on Wednesday of each week.  Please do not come out to say hi as we want to maintain social distancing.  We will drop your purchase off at your designated location.  Thank you and stay well.    
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Name (First and Last) *
Phone Number (cell) to text you when delivery has been made.
Delivery address *
Special delivery instructions like beware of dog, put package by the side door, please put by the garage door, etc. *
Please choose the equipment that you would like to purchase and have delivered.
If a piece of equipment that you would like is not listed please let us know the name of that piece of equipment below and we will see what we can do to help you.
Agree to pay delivery fee *
Total your purchase up (include addition costs and delivery fee).  Thank you! *
Copy and paste this link to pay https://sportspinept.securepayments.cardpointe.com/pay  
or go to our website and hit the "Pay Now" button. www.nhsportandspine.com.                                                                                   Once you have paid then submit this form.
I would like to be contacted about Telehealth options for physical therapy *
If you answered yes above please let us know the best way to contact you for Telehealth.  (type phone # or email below).
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