6772 Johnston ST, Suite 1300

Lafayette, LA 70503
(337) 534 8052
info@tricitypt.net

233 Doucet Road Suite B-2

Lafayette, LA 70503
(337) 991 9972
info@tricitypt.net

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New Patients

TALK TO A THERAPIST

One of our licensed physical therapists will contact you shortly to discuss your questions.

Name*
First Last
Reason for wanting to speak to one of our PTs:
- I’m having pain and unsure what to do to manage my pain
- I am unsure that PT will help me and I would like to speak with someone first before making an appointment
- I am wanting to find out more information about your clinic and what it has to offer me
Where does it hurt ?*
- Head / Neck
- Shoulder
- Lower Back
- Knee
- Foot / Ankle
- Hip
- Previous Injury
- Unsure on where pain is coming from
What activities or hobbies are you unable to do because of your pain?*
How long have you been having your pain?*
- A few days
- 1-2 weeks
- 2-4 weeks
- Several Months
- Multiple Years
Primary goal of pursuing physical therapy?*
- Figure out what is wrong
- Alleviate Pain
- Get back into recreational activity
- Become more flexible, stay healthy
Best Time for us to call you?*
- Morning
- Afternoon
- After 5pm
- Anytime
Phone*
Email*
Email
This field is for validation purposes and should be left unchanged.

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Hours of Operation

Monday: 7am – 5pm
Tuesday: 7am – 5pm
Wednesday: 7am – 5pm
Thursday: 7am – 5pm
Friday: 7am – 12pm

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Get in Touch with Us

233 Doucet Road Suite B-2
Phone: (337) 991 9972
Fax: (337) 991 9974

6772 Johnston st, Suite 1300
Phone: (337) 534 8052
Fax: (337) 534 8622

Email: info@tricitypt.net

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