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4703 S Lakeshore Dr #2
Tempe, AZ 85282
Call or Text Us:
(480) 718-9493
Back Pain & Sciatica
Knee Pain
Neck Pain
Shoulder Pain
Arthritis Pain
Back Pain & Sciatica
Knee Pain
Neck Pain
Shoulder Pain
Arthritis Pain
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Physical Therapy
Neuromuscular Re-education
Hands-on Manual Therapy
Quality One-on-One Initial Evaluation
Dry Needling
Blood flow Restriction
Bio-Identical Hormone Therapy
Food Sensitivity Testing
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Home
Services
Physical Therapy
Neuromuscular Re-education
Hands-on Manual Therapy
Quality One-on-One Initial Evaluation
Dry Needling
Blood flow Restriction
Bio-Identical Hormone Therapy
Food Sensitivity Testing
Auto-Vehicle Accidents
Massage Therapy
Revive Dispensary
About
Location
Careers
Staff
Reviews
Patient Center
1st Visit Video
Medical Library
Patient Forms
Insurance
Links
FAQ
News
Privacy Policy
Contact
MENU
Home
Services
Physical Therapy
Neuromuscular Re-education
Hands-on Manual Therapy
Quality One-on-One Initial Evaluation
Dry Needling
Blood flow Restriction
Bio-Identical Hormone Therapy
Food Sensitivity Testing
Auto-Vehicle Accidents
Massage Therapy
Revive Dispensary
About
Location
Careers
Staff
Reviews
Patient Center
1st Visit Video
Medical Library
Patient Forms
Insurance
Links
FAQ
News
Privacy Policy
Contact
Directions To:
4703 S Lakeshore Dr #2 Tempe AZ 85282
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1744
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Your Name
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First
Last
Which services do you need?
Physical Therapy
Bioidentical Hormone Therapy
Nutrition Consult
Massage Therapy
Where does it hurt?
Back
Knee
Hip
Shoulder/Neck
Foot/Ankle
Wrist/Hand
Not sure where it’s coming from
I don't have pain
What does it stop you from doing?
Your main concern:
The pain you are experiencing
The fear of not being able to stay involved in activities
Worry about not knowing what’s wrong
Want to avoid painkillers
Concern at no sign of improvement
Future ill health (and wanting to prevent it)
How long have you suffered or worried?
A few days
1-2 weeks
2-4 weeks
1-3 months
Long enough
Too long (years)
What do you value most when making your decision to choose a physical therapist? (check all that apply)
Natural treatments
Hands on care (example: massage, manual therapy)
Quality time with provider
Home exercises to speed up your recovery
Learning how I can help myself and take control of my health
The main goal you would like us to help achieve for you
Ease pain
Ease stiffness
Stay active
Avoid painkillers
Find out what’s wrong
Stay healthy and get better before the symptoms gets worse
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Step 1 of 3
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Your Name
*
First
Last
Primary reason for wanting to
I’m in lots of pain and want some tips and advice I can start using right away
I would love to know what’s wrong and how long it will take to ease
I’m not sure if physical therapy is right for me and talking to a physical therapist first would help me decide.
Where does it hurt?
Back
Knee
Hip
Shoulder/Neck
Foot/Ankle
Wrist/Hand
Not sure where it’s coming from
What does it stop you from doing?
What’s concerning you the most?
The pain you are experiencing
The fear of not being able to stay involved in activities
Worry about not knowing what’s wrong
Want to avoid painkillers
Concern at no sign of improvement
Future ill health (and wanting to prevent it)
How long have you suffered or worried?
A few days
1-2 weeks
2-4 weeks
1-3 months
Long enough
Too long (years)
Best day for a call back
Monday
Tuesday
Wednesday
Thursday
Friday
Best time for a call back
Morning
Afternoon
Evening
Best phone number
Best email
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