Request an Appointment

Request physical therapy at any of our 7 Locations

TROY (2) – COMMERCE – SHELBY – SOUTHFIELD – ROYAL OAK – ROCHESTER HILLS

 

Same-day appointments may often be available so please call the office of your choice if you want an appointment today.

Please be aware that you are submitting a request only. A representative from our office will contact you within 24 to 48 business hours to confirm a date and time.

If this is a medical emergency, please do not fill out this form, call 911.

Full Name (required):
Phone (required):
Email (required):
Address (required):
City, State & Zip:
Date of Birth:
Best way to reach you (required):
Type of Patient (required):
Type of Appointment (required):
Reason for Appointment:
Who may we thank for referring you?
Preferred Location:
Preferred Day (required):
Preferred Time:

Additional Comments:

captcha - (REQUIRED) - Please type in the security code and click Send.

© 2018 OMPT Specialists, Inc. - All Rights Reserved