Arrange Your Free (15 Minutes) Telephone Consultation With a PhysiCAL THERAPIST

So That We Can Meet 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…

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 Speak With a Specialist *

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 get better
I'm not sure if PT is right for me and talking to a PT first would help me decide

Where Does It Hurt? *

What Does It STOP You From Doing? *

What Is Concerning You Most? *

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)

Main Goal With Speaking To Our Specialist Physical Therapist *

So that we can arrange this Complimentary Telephone Consultation for you, please tell us:

Best Time For a Call Back *

During the Day (8am-5pm)
After 5pm
Any time

Best 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.

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

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