Request an Appointment

Patient Name (please use one form for each patient) *

First Name

Last Name

Contact Phone Number *

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What services are you interested in?

Physical therapy

Occupational therapy

Speech therapy

Pelvic Health Therapy

Dry needling

Kids camps

Other

What location are you interested in?

Chippewa Falls Clinic

Rice lake Clinic

In-Home Concierge Services (**private pay only)

Other