Physical Therapist

Request an evaluation with Rebecca

Tell us a little about your family and a few times that work — we'll confirm within one business day.

Your information

Your name*

Phone*

Email*

I agree to the terms and privacy policy.

What brings you here?*

What does your child need help with? Pick at least one.

Please describe in more detail*

Where would you like therapy?*

Select any that apply — we'll ask for each address.

When are you generally free?*

Pick at least one window. This isn't your appointment time — the more windows you select, the better the chance of finding a time that works for therapy. We'll follow up to lock in the exact day and time.

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Morning8–12

Afternoon12–3

After School3–5

Evening5–8

Payment*

How would you like to handle payment?

Your child

We use this to verify benefits under your child's name and start their file.

Child's first name*

Needed to check your insurance under their name.

Child's last name*

Date of birth*

By submitting, you agree Origin Therapy may contact you about scheduling. We never share your information.