Complete The Survey To Book A Physical Therapy Consult With Amy

First Name *

Last Name

Email *

Phone *

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What is the main issue or injury you’d like help with? *

What activities are currently limited because of this? *

Have you had any treatment for this issue before? *

What is your current training or activity level? *

Are you currently in pain? If so, when and what does it feel like? *

Do you have any other injuries, surgeries, or medical history we should know about? *

What is your long-term goal for working together? *

Why is this important to you right now? *

Have you worked with a physical therapist before? If so, how was your experience? *

Are you looking for a one-time assessment or ongoing performance-based care? *

One-time check

Short-term plan (4–6 sessions)

Long-term strategy and performance program

If we’re a great fit, are you ready to make the time, energy, and financial investment to reach your goals? *

Yes, I’m ready to commit

I’m serious, but I need more details

Not ready to invest right now (I am disqualifying myself to not waste your time)

On a scale of 1–10, how much of a priority is your health and nutrition right now—emotionally and financially? *

Powers Performance PT is an out-of-network, performance-based clinic. Are you aware that we do not directly bill insurance, and are you comfortable with that model?

Yes, I understand and am ready to invest in expert care

I wasn’t aware, but I’m open to learning more

No, I only want to use my insurance benefits

Once you hit submit below, you will be taken to the booking page. This form is a requirement to book a call. If it is not filled out pre-booking, your call will be cancelled.

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