Physical therapy
discovery session

Name *

First Name

Last Name

Phone *

(###)

###

####

What is the MAIN reason you're interested in a Discovery Session? *

I’m not sure if Physical Therapy is the right thing for me?

I'd like to get an understanding of what's causing my pain/injury and what you can do to help me before I commit to a full appointment.

I've never tried Physical Therapy and I would like to learn more before I decide.

I would like to see the space and meet my therapist so I can decide if it feels like a good fit for me.

I have tried physical therapy before and I want to know how my experience at Sakash Health and Wellness might be different.

What's your MAIN concern or problem area? *

Low Back

Mid/Upper Back

Neck

Shoulder

Hip

Knee

Ankle/Foot

Elbow

Wrist/Hand

I’m not sure where the pain is coming from?

Other

How long have you been dealing with or worrying about this? *

It just happened - only a few days

A few weeks

A few months

One year or more

Not really a problem - looking mainly for prevention

What concerns you most about your pain/injury that’s making you consider physical therapy? Please select one. *

Not knowing what is wrong and what is causing the pain

Having to take painkillers to ease the pain

Being limited in how much I can exercise/play my sport/ stay active

Losing mobility or independence

The risk of facing surgery

Other

What is the main goal that you would like to achieve with us? Please select one. *

Find out what is wrong and why I’m still having pain

Find out if physical therapy can help with my pain/injury

Create a solid plan for fixing the problem

Get to know the clinic and therapists and make sure that it is a good fit for me

Other