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So That We Can Serve Your SPECIFIC Needs, Please Fill Out This 35 Seconds Form And Show Us EXACTLY How You Want Us To Help YOU… The more we know about you, the better we can help you…

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Primary Reason For Wanting To Talk With A Specialist

I'm in lots of pain and want some tips and advice I can start using straight 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?*

If Other Please Describe Here (optional):

What Does It Stop You From Doing?*

What Concerns You The Most That Makes You Want To Consider Physical Therapy?*

How Long Have You Suffered or Worried?

Haven't - This is prevention (not cure)

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2-4 Weeks

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LeBauer Physical Therapy, LLC 319 Smyres Pl. Greensboro, NC 27403 336-271-6677 info@LeBauerPT.com

Helping active people stay fit, healthy and mobile without medications, injections or surgery since 1999.

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