Request an Appointment

Sprains, Strains, or Injuries, we make getting the care you need easy.

Request an in-clinic or virtual appointment at a time that works best for you. Our Patient Experience Coordinator will use this info when they call to confirm your request.

Click here to learn how we protect your privacy.
First Name*
Last Name*
- I am submitting this appointment request for my partner, child, parent or friend.
Their name*
Their Date of Birth*
Month
Day
Year
Email*
Phone*
Your Date of Birth*
Month
Day
Year
State*
Zip Code*
Clinic Location:*
I have a prescription from my doctor for:*
- Physical Therapy
- Occupational/Hand Therapy
- I do not have a prescription
*You may be able to receive services without a prescription from your doctor. Our team will inform you when they contact you about your appointment.
*Now in Illinois, you no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
*You no longer need a prescription for physical therapy.
Please list your doctor’s name*
Best Time to Contact/Other Details:*
Other than a referring doctor, how did you hear about us?*
Please specify the name of the individual, event, organization or group*
By clicking this box you agree to receive email communication regarding appointment updates and marketing communication from Athletico Physical Therapy.
- I agree
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Request an Appointment

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