Be the bestVersion of you with X3 Performance and Physical Therapy. 15 Minute Form Name First Last Email PhoneLocation(Required)NashvilleFt. MyersBest Day to contact you?(Required)MondayTuesdayWednesdayThursdayFridayBest time of the day to call?(Required)Anytime8a-11a11a-2p2p-5pPlease let us know what is on your mind so we can provide feedback and prepare for your FREE 15-minute phone consultation.(Required) Inquiry Name(Required) First Last Email(Required) Phone(Required)Which Location are you wanting to visit?(Required)NashvilleFt. MyersMessage(Required) Discovery Visit Name(Required) First Last Phone(Required)Email(Required) Locations(Required)NashvilleFt. MyersWhich service are you interested in?(Required)Physical TherapyPerformance TrainingSelect all reasons for wanting a Physical Therapy Discovery Session?(Required) I’m new to Physical Therapy and not sure what to expect. I was let down by another healthcare provider in the past and would like see if we are a good fit for each other before I commit. I’m not yet sure if Physical Therapy can even help me. I’d like to get an understanding of what’s causing my pain/injury and what you can do to help me before I commit to a full appointment. It’s just easier to get started this way. Where is your pain or stiffness?(Required) Lower back Mid/Upper back Neck Shoulder Elbow Hip Knee Ankle/Foot Mutliple Body Parts Not sure Not Listed Above What Concerns You Most About Your Pain/Injury That's Making You Consider Physical Therapy?(Required)Not knowing what is wrong and causing the pain.Having to take pain killers to ease the pain.Being limited on how much I can exercise/play my sport/stay active.Losing mobility or indepenceThe risk of facing surgeryOther - not listedHow long have you suffered or worried?(Required)2 weeks or less2-4 weeks1-3 months4mo - 1 yearOver a yearYouth or Adult?(Required)YouthAdultWhat is the main goal you would like to achieve?(Required) Strength Speed Cardio Power What is your main sport/activity?(Required)What is the main goal that you would like to achieve working with us?(Required)
