Request An Appointment At Element Wellness and Sports Rehabilitation Name * First Name Last Name Phone * (###) ### #### Email * Requested Appointment Date * Note: Closed Sunday MM DD YYYY Requested Appointment Time We will do our best to accommodate time requests 7:00 am 7:30 am 8:00 am 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm 5:00 pm Reason For Your Visit * Please specify if your injury is due to a motor vehicle accident, workplace injury, or other Who Would You Like To See? We will do our best to accommodate provider requests as some of our practitioners are booked several weeks out Brooke Bailey, Physical Therapist Alix Sklarew, Physical Therapist Cristiana Ciorba, Physical Therapist Adam Dew, Chiropractic Physician Christina Goodwill, Physical Therapist Noah Goodwill, Chiropractic Physician Luke Haroldson, Chiropractic Physician Jessamyn Sajko, Massage Therapist Rebecca Mendak, Physical Therapist Shea Vallaire, Personal Trainer How Did You Hear About Us? * Will You Be Using Insurance? Yes No What insurance will you be using? * Thank you for your request! We will do our best to accommodate the options you selected. Someone from our clinic will be reaching out to you shortly!
