Thank you for your interest in Life Health Strength Rehabilitation. This form is used to collect necessary information before your desired appointment time. This information will not be used or sold to outside parties.
If the potential client is a minor, please indicate that below and fill out the fields with the guardian's contact information.
If you desire a same-day or next-day appointment, it is best to call the office to schedule the appointment.
If you have any questions, please contact us via phone or email:(267) 297-6499 • firstname.lastname@example.org.
We look forward to working with you!