Physical Therapy Appointment Request

Please fill out the information below and provide a valid email address or phone number that you can be reached at. You may expect us to contact you within 1 business day to schedule an appointment. If you need assistance, please call 317-355-7868. Thank you!


Patient Information

Include type of therapy and, if applicable, body part/areas that will be treated.

Contact Information

Please include an email address or phone number that we can reach you at.
How do you wish to communicate with us?
If you choose email, please answer some additional questions below to assist us with scheduling your appointment.
Does patient have a physician referral or is this a self-referral?