2505 RACQUET LANE 3904 TERRACE HEIGHTS DRIVE STE A 509-453-PEAK (7325) Request an Appointment Please enable JavaScript in your browser to complete this form.Name *Email *Phone Number *Insurance *NonePrivateMedicareWorkers' CompInsurance CompanyInsurance ID NumberDo you want us to verify insurance benefits before appointment?Appointment Request *Insurance QuestionCall from a TherapistAppointmentOtherWebsiteSubmit REQUEST APPOINTMENT New Patient Intake Form NEW PATIENT INTAKE FORM SERVICES MEET THE TEAM TESTIMONIALS BLOG PATIENT RESOURCES NEW PATIENT INFO PRIVACY PRACTICES NEW PATIENT FORMS MOTOR VEHICLE / ON THE JOB INJURY FORM NECK PAIN OUTCOME FORM LOWER EXTREMITY FORM DISABILITIES OF THE ARM FORM CAREERS CONTACT Please enable JavaScript in your browser to complete this form.Full Name *MaleFemaleMinor?YesNoResponsible Party Name & PhonePrimary PhoneWork Phone Date of BirthSSNAddress:CityStateZip CodeDate of InjuryEmployerOccupationEmail *Referring PhysicianPrimary PhysicianHow did you hear about us?DoctorFamily/FriendRadioNewspaperYellow Pages DEXYellow Pages imPactPrevious PatientOther (Specify)Restrictions when we call?YesNoPhoneSubmit