New Patients OA.

Today's Date*

First Name*

Last Name*

Email*

Phone*

Check the box below if you agree to the following:*

I agree to the privacy policy and terms & conditions provided by the OneAccord PT and The Pelvic Docs. By providing my phone/email, I agree to receive text messages and emails from OneAccord PT & The Pelvic Docs.

Address/City/State/Zip Code*

What is your Gender?*

Select or enter value

What is your Date of Birth?*

Which location would you like to see one of our specialists at? **

Select or enter value

Are you an existing patient?*

Yes

What brings you in to see a physical therapist?*

Our waitlist for new patients is currently 2-6 weeks. How urgent is your need to see a specialist?*

Extremely Urgent (I need to see a specialist ASAP)

Urgent (I need to see a specialist within 1-2 weeks)

Not Urgent (I can wait 2-6 weeks to see a specialist)

Do you have a doctors referral?*

Yes

How will you be paying for your services?*

*We offer a hybrid care model that blends traditional insurance-covered services with specialized treatments like Dry Needling, Shockwave therapy, and our exclusive "Movement is Life" program. These offerings aim to elevate your health journey beyond the standard care.

While we work to leverage your insurance for covered treatments, be aware that some specialty services may not be insured and thus require out-of-pocket payment. We value clear communication and informed decisions, so please feel free to discuss your care options with us. By checking a box below, you understand the above to its entirety.

Please upload your supporting documents here (If applicable)

EXAMPLE: A picture of your insurance card (front and back) and/or doctors referral OR text us a picture to 480-701-8822!

Drag and drop files here or

What is your #1 Goal to achieve with Physical Therapy?*

What is your #2 Goal to achieve with Physical Therapy?

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