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Free Discovery SessionSarah Mayhew2018-10-23T14:59:42+00:00

1About You

2Your Requirements

3Finish Up!

What Is Your First Name?*
First
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 a Physical Therapist 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 Is Your Pain?*
What Does It Stop You From Doing?*

What Is Concerning You Most That Makes You Want To Consider Physical Therapy?*
What Would Be The One Thing You Would Like Us To Achieve For You?*
How Long Have You Suffered Or Worried?*
- I haven't - this is prevention
- A Few Days
- 1-2 weeks
- 2-4 weeks
- 1-3 months
- Long Enough
- Too Long (Years)

Best Phone*
Best Email*

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JOHN GOETZE PHYSICAL THERAPY
1400 Marsh Landing Parkway, Suite 112
Jacksonville Beach, FL 32250
Phone: (904) 280-2001
Fax: (904) 245-1865
Email: info@manualpt.com

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