Request a Physical Therapy Appointment

During this time, our clinics will remain open to deliver on our promise of providing safe, affordable and effective rehabilitation services to all of our patients. The safety of our patients and employees is extremely important to us and we are following the guidelines of the CDC and other health authorities to provide the safest environment for all.

We will provide a telehealth or virtual care option for individuals who want to take additional safety precautions. After completing this form, an Athletico staff member will contact you within 24 business hours to schedule your appointment.

First Name*

Last Name*

I am submitting this appointment request for my partner, child, parent or friend.

Their name*

Their Date of Birth*

Email*

Phone*

Your Date of Birth*

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.

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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