Apply for a “Discovery” Visit (to See if You Like it…)

Please Watch the Video and Then Fill Out This Form to Apply for Your Discovery Session. Hurry: These sessions are limited and are provided on a first-come, first-served basis...

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

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Please Enter Your First Name *

Please Enter Your Last Name *

Primary reason for wanting to start with a Discovery Session? *

I am new to Physical Therapy and not sure what to expect
I'm Not Sure If Physical Therapy Con Solve My Problem
I'd Like To Know More Before I Commit
I Want To Meet A PT To Make Sure It's Right For Me

Where Does It Hurt? *

What Does It STOP You From Doing? *

How Long Have You Suffered or Worried? *

Haven't - I want to be ProActive about my health (wellness)
A Few Days
1 - 4 Weeks
1 - 3 Months
4 - 12 Months
More Than A Year

What Is the Main Goal You Would Like Us to Help You Achieve? *

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

Best Time For A Call Back? *

Phone Number *

Best Email *

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

All of your details are 100% safe with us.

812 Lyndon Ln, Suite #101,Lyndon, KY 40222
502.512.2165
info@proactiveptlou.com

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