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Contact Us Today! Why Wait? 

Give us a call, send an email, or simply fill out the form below that best suits your contact needs. Same Day and Next Day Appointments available! We guarantee to reach out to you within 24 hours of receiving your inquiry!


Please Fill Out The Form Below That Best Suits Your Needs

NEW PATIENTS NEVER SEEN AT OUR OFFICE

Name*

Phone*

Email Address*

Person Making Appointment*

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Insurance Type*

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If you've chosen "other" for insurance type, indicate the insured's insurance type

Start Treatment Date*

Do you have a referral for PT?*

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Referring Dr. or PCP

Additional Information

MEDICAL NOTES REQUEST

First and Last Name*

Email Address*

Telephone Number*

Relation to Patient*

Name & DOB of Patient*

Fax Number

Deadline Date

Comments

I WAS ONCE A PATIENT AT YOUR OFFICE, I NEED TO SCHEDULE PT AGAIN

Patient's First and Last Name*

Patient's DOB*

Email Address*

Telephone Number*

Your Relation to Patient*

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Preferred Method of Communication*

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Patient's Insurance*

Target PT Start Date*

PT/PTA worked with in past at FPT*

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Therapist Preference for Upcoming PT

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Additional Comments

misc. inquiry form. help us better assist you with completin​g form below

First and Last Name*

Phone*

Email Address*

Inquiry Reason*

Address

196 Thomas Johnson Drive, Suite 225, Frederick, MD 21702


We are located in the Thomas Johnson Medical Center ​

Contact

Tel: (301)631-5300

Fax: (301)631-5301


Hours

M-Th 7:30am-6:10pm

Fri 7:30am-3:10pm

Sat 8:00 am-12:00pm

Sun Closed

Email: AlSchmitt@FrederickPhysicalTherapyInc.com

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