Request an Appointment

Please use this link to schedule your initial evaluation with one of our experienced physical therapists:  

https://scheduling.go.promptemr.com/onlineScheduling?w=1273&s=DL

OR

You can complete the appointment request form below. Our office staff will contact you to confirm your appointment.

Patient Information

Patient Name:
Patient Date of Birth:
New or Existing Patient?	New Patient Existing Patient
Home Phone:
Cell Phone:
Preferred Contact Method:	Home Phone Cell Phone
SMS Consent:	I agree to receive conversational SMS messages from Milestone Physical Therapy related to inquiry responses, confirmations and schedule updates. Message frequency varies. Message and data rates may apply. For assistance, text HELP. To opt out, reply STOP. Learn more about our Privacy Policy and SMS Terms.
Email Address:
Insurance:

Appointment Information

Preferred Location:	No PreferenceSouth Indy ClinicLawrence ClinicFishers Clinic
Preferred Therapist:	No PreferenceBrad Howell, DPT, OCSBrad Shupe, PT, DPT, CSCSCassandra Williamson, DPTDave Mason, PTA
Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Preferred Time:	Morning (AM) Afternoon (PM)
Secondary Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Secondary Preferred Time:	Morning (AM) Afternoon (PM)
Question/Comment: