Apply for a Free Physical therapy Assessment (to See if You Like it…)

Step 1 About you
Step 2 Your Pain/Injury
Step 3 Finish!

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Please Enter Your First Name *

Primary Reason For Wanting to Sample Physical Therapy *

I'm new to physical therapy and not sure what to expect
I was let down by another physical therapist in the past and would like see how good you are before I commit
I'm NOT sure if physical therapy can even help me
I'd like to get a feel for what you can do to help me BEFORE I commit to a full appointment
It's just easier for me doing it this way

Where Does It Hurt? *

What Does It STOP You From Doing? *

What Is Concerning You Most That Makes You Want To Consider Physical Therapy? *

How Long Have You Suffered Or Worried? *

I haven’t; this is prevention not cure
A few days
1-2 weeks
2-4 weeks
1-3 months
Long enough
Seems like too long (years)

Your Main Goal That You Would Like To Achieve With Us *

Please tell us where to contact you with the outcome of the Free Discovery Session application:

Phone Number *

Best Email *

Then please check your email account in the next 10 minutes for a personal reply from the Impact PT & Wellness team.

All of your details are 100% safe with us.

By submitting, you authorize Impact Physical Therapy and Wellness, LLC to send text messages with offers and other information. Message/data rates apply.

4295 Sergeant Rd, Sioux City, IA 51106 (712) 560-0460 | 140 Reed St. Akron, IA 51001 (712)-568-3111

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FREE
Transformation Assessment!

YOUR NAME:

YOUR EMAIL:

YOUR PHONE:

WHY DO YOU WANT TO GET FIT?