Request an Appointment

Thank you for choosing Water & Sports Physical Therapy. We are excited to be your provider of choice. Please select an option below to get started.

New Patient

"*" indicates required fields

Name

First Last

DOB

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Insurance Name

Insurance ID

Insurance Group Number

What are you coming in for?

Physician (if applicable)

What specific body part are you having a problem with?

Are you currently in pain? If not, when do you have pain?

How long have you suffered with this problem?

What activities does your pain or problem keep you from doing what you enjoy?

Have you seen someone for this before/what else have you tried?

How did you hear about us?

If "Other" how did you hear about us?

If "Other Insurance", which insurance company?

Preferred Location

List three appointments dates and times you would like to request

By checking this box, I understand that this is an appointment request and is not finalized until a patient care coordinator reaches out to me to confirm.

We are committed to maintaining the accuracy, confidentiality, and security of your personally identifiable information. As part of this commitment, our privacy policy governs our actions as they relate to the collection, use, and disclosure of personal information.

Our privacy policy is based upon the values outlined by the American Privacy Rights Act, and your information will not be shared with third parties for marketing purposes.

Texting from our office will exclusively be related to practice-related information, such as appointment reminders and communication regarding your healthcare, and will not be used for any other purpose. Message and data rates may apply depending on your carrier's plan.

There are opt-out prompts via this messaging should you choose to opt-out in the future.

Current Patient

"*" indicates required fields

Name

First Last

DOB

Phone

What are you coming in for?

Physician (if applicable)

Preferred Location

List three appointments dates and times you would like to request

By checking this box, I understand that this is an appointment request and is not finalized until a patient care coordinator reaches out to me to confirm.

Request An Appointment

New Patient

Current Patient

CARMEL VALLEY

CARMEL VALLEY (POOL)

CORONADO

CORONADO (POOL)

MISSION BEACH

MISSION BEACH (POOL)

DOWNTOWN

DOWNTOWN (POOL)

SCRIPPS RANCH

Scripps Ranch Pool

POWAY

LA JOLLA

UTC

SDCST