Schedule an Appointment

Please fill out the form below and one of our scheduling representatives will reach out within 24 hours to schedule your appointment!

First Name*

Last Name*

Email*

Phone*

Insurance Provider*

What body part is injured or needs to be treated?*

Select a Confluent Health PT Location*

Questions, Comments, or Reason(s) for Visit

Is this appointment related to an auto accident or work-related injury?*

Yes

How Did You Hear About Us?*

Doctor Referral

Friend or Family Member

Radio

Google

Social Media

Other

How would you prefer to be contacted to schedule your appointment?*

Phone

Text

Consent*

I understand this communication may be unsecure and consent to being contacted by text or email. I understand that sensitive or individually identifiable health information may be disclosed to an unauthorized party.

Please verify your request*

Other Ways to Schedule an Appointment

Call Us now

Want to talk to a care coordinator right now? Give us a call at (770) 290-8002.

Chat With Us now

Got questions but don't feel like calling? Click the Live Chat button at the top right.

If it's after hours, we'll get back with you as soon as we're back in the office.

Helpful resources for your road to recovery.

Please print the New Patient Paperwork and bring the completed forms with you to your first appointment.

New Patient Paperwork

(770) 290-8002 LetsTalk@ConfluentPT.com

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