Request an Appointment

Please use this link to schedule your initial evaluation with one of our experienced physical therapists:  

https://scheduling.go.promptemr.com/onlineScheduling?w=1273&s=DL

OR

You can complete the appointment request form below. Our office staff will contact you to confirm your appointment.

Patient Information

Patient Name:
Patient Date of Birth:
New or Existing Patient?	New Patient Existing Patient
Home Phone:
Cell Phone:
Preferred Contact Method:	Home Phone Cell Phone
Email Address:
Insurance:

Appointment Information

Preferred Location:	No PreferenceSouth Indy ClinicLawrence Clinic
Preferred Therapist:	No PreferenceBrad Howell, DPT, OCSBrad Shupe, PT, DPT, CSCSCassandra Williamson, DPTDave Mason, PTA
Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Preferred Time:	Morning (AM) Afternoon (PM)
Secondary Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Secondary Preferred Time:	Morning (AM) Afternoon (PM)
Question/Comment: