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Mike Kohm PT, Physical Therapy, Boulder, Denver
Treatment Approach
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Online Physical Therapy Scheduler Boulder, Denver
Neuromuscular Strategies Physical Therapy
Functional Movement Screen
Free Physical Therapy Phone Consultation
Yoga Movement Screen
Bike Fit Boulder
Consultations for Worksite Builds, Injury Prevention in the Workplace
Trigger Point Dry Needling
Selective Functional Movement Assessment
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Home
About
About Mike Kohm PT
Mike Kohm PT, Physical Therapy, Boulder, Denver
Treatment Approach
Testimonials
services
Online Physical Therapy Scheduler Boulder, Denver
Neuromuscular Strategies Physical Therapy
Functional Movement Screen
Free Physical Therapy Phone Consultation
Yoga Movement Screen
Bike Fit Boulder
Consultations for Worksite Builds, Injury Prevention in the Workplace
Trigger Point Dry Needling
Selective Functional Movement Assessment
News
Covid Policy
Marshall Fire
Insurance Information
Inquire About Pricing & Availability
Med-Pay Physical Therapy
blog
Schedule
PT Consulting
Contact
Subscribe to our email list
Location
Schedule Now
Home
About
About Mike Kohm PT
Mike Kohm PT, Physical Therapy, Boulder, Denver
Treatment Approach
Testimonials
services
Online Physical Therapy Scheduler Boulder, Denver
Neuromuscular Strategies Physical Therapy
Functional Movement Screen
Free Physical Therapy Phone Consultation
Yoga Movement Screen
Bike Fit Boulder
Consultations for Worksite Builds, Injury Prevention in the Workplace
Trigger Point Dry Needling
Selective Functional Movement Assessment
News
Covid Policy
Marshall Fire
Insurance Information
Inquire About Pricing & Availability
Med-Pay Physical Therapy
blog
Schedule
PT Consulting
Contact
Subscribe to our email list
Location
Menu
Home
About
About Mike Kohm PT
Mike Kohm PT, Physical Therapy, Boulder, Denver
Treatment Approach
Testimonials
services
Online Physical Therapy Scheduler Boulder, Denver
Neuromuscular Strategies Physical Therapy
Functional Movement Screen
Free Physical Therapy Phone Consultation
Yoga Movement Screen
Bike Fit Boulder
Consultations for Worksite Builds, Injury Prevention in the Workplace
Trigger Point Dry Needling
Selective Functional Movement Assessment
News
Covid Policy
Marshall Fire
Insurance Information
Inquire About Pricing & Availability
Med-Pay Physical Therapy
blog
Schedule
PT Consulting
Contact
Subscribe to our email list
Location
Schedule Now
Inquire About Pricing & Availability
SO THAT WE CAN SERVE YOUR SPECIFIC NEEDS, PLEASE FILL OUT THIS 35 SECOND FORM AND SHOW US EXACTLY HOW YOU WANT US TO HELP YOU… THE MORE WE KNOW ABOUT YOU, THE BETTER WE CAN HELP YOU!
First Name
Last Name
Telephone #
Email
What Service Do You Need?*
Physical Therapy
Triggerpoint Dry Needling
Performance assessment
Private Yoga
Myofascial release
Please Choose Your Ideal Day For An Appointment
Monday
Tuesday
Wednesday
Thursday
Friday
Please Indicate Your Ideal Time (We’re open 8am – 6pm)*
8AM
9AM
10AM
11AM
12PM
1PM
2PM
3PM
4PM
5PM
Where Does It Hurt?
Lower back knee
Neck/Shoulder
Foot/Ankle
Hip
Pelvic Region
Headaches/Migraine
Muscle injury From Sports/Exercise
Not Sure Where it is coming from
How Long Have You Suffered or Worried?
Have Not-This is prevention
Interested in a movement screen (not cure)
A Few days
1-2 Weeks
2-4 weeks
1-3 months
Long enough (4+ Months)
What Does It Stop You From Doing?
What Concerns You The Most That Makes You Want To Consider Physical Therapy?
The Pain You Are Experiencing
Not knowing what's wrong
Want to avoid pain killers & medications
Fear of not being able to stay active
The risk of needing surgery
Concern at no sign of improvement
Check any of the boxes below that you value most when making your decisions to choose a physical therapist
Natural Treatments – Don't want medications or pain killers
Hands on care (manual therapy, triggerpoint dry needling , myofascial release, etc)
One on one care
Home exercises & self-treatment to speed up your recovery
Ability to limit the chance that the pain will return anytime soon
The #1 Thing You Would Like to Achieve From Physical Therapy
Send