Appointment Request Page — ACRO: Physical Therapy, Massage Therapy & Aerial Fitness

Appointment Request Page — ACRO: Physical Therapy, Massage Therapy & Aerial Fitness

In-Clinic Physical Therapy Appointment Request

In-clinic treatments are only available to patients with an open case with ACRO Physical Therapy, with the approval of the treating therapist. To open a new case, please schedule a telehealth session for an initial evaluation.

Name

First Name

Last Name

Email

Cell Phone Number

(###)

###

####

How should we contact you to schedule your appointment?

Daytime Phone

Email

Reason for visit

Have you had a telehealth session with ACROPT for this issue in the past 30 days?

Who was your treating therapist?

Additional notes or changes since your last telehealth session

All patients and staff will be required to wear a mask during in-clinic sessions. All patients will be required to wash their hands upon entry.

I understand and agree to the above statement

A COVID-19 pre-screening survey will be sent to you prior to your session. It must be submitted prior to your appointment. If you are experiencing any symptoms, your session will be cancelled with the cancellation fee waived.

I understand and agree to the above statement

To reduce exposure, ACROPT will be using a virtual waiting room system. Patients should remain in their car/outside of the building until called by our staff.

I understand and agree to the above statement

To adhere to strict physical distancing protocols, appointment times will be strictly observed. Should you arrive too late for your appointment (>15 minutes), you will be charged the cost of a direct pay session ($100 + $5 COVID fee), not payable by insurance.

I understand and agree to the above statement

Each in-clinic session will require an additional $5 COVID surcharge collected at the time of booking. This fee is not covered by insurance and helps to cover the cost of PPE and COVID-19 safety measures.

I understand and agree to the above statement