Request Appointment

Your name

Your Phone Number

Your email

Insurance Provider

Body Part Needing Therapy

Do you have a referral from a Doctor?
YesNo

Select Clinic of Choice
Carroll Road ClinicClinton Mayhew ClinicIllinois Road ClinicNew Haven ClinicQuimby Village ClinicStellhorn ClinicVestibular ClinicWest Jefferson ClinicAvon ClinicCamby ClinicSouth Emerson ClinicAngola ClinicAuburn ClinicBluffton ClinicColumbia City ClinicDecatur ClinicElkhart ClinicGoshen ClinicHuntington ClinicKendallville ClinicMichawaka ClinicWarsaw Clinic

How did you hear of us?
Previous positive experience at IPTMy doctor recommended IPTConvenient locationFriend or family recommendationIPT employee recommendationRadio or TV adCommunity event involvement

Your message (optional)

Δ