Aquatic Therapy Sessions
Sign up for FREE Aquatic Therapy Sessions by completing this form.  
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Last Name *
First Name *
Age *
Email Address *
Phone Number *
Do you prefer to be contacted by phone or email? *
Do you have any of the following conditions? *
Yes
No
Large or small open wounds
Bowel or Bladder Incontinence
Infection(s) of any kind
Cardiac Failure
Unstable Blood Pressure
Deep Vein Thrombosis
Epilepsy
Renal Disease or Dysfunction
Any Contagious Disorders
Compromised Immune Function
Severe Respiratory Disease
Diarrhea
Are you comfortable in shallow water?  
**Swimming skills are not necessary
 *
How would you gain access to the WVU Recreation Center? *
What is your availability for Aquatic Therapy Sessions?  
Sessions are available on Monday, Wednesday and Friday from 11:30-5:00.  
Please list all that apply 
 *
What are your primary reasons for wanting to take part in aquatic therapy (physical limitations, disorders, diseases, etc)?   *
What do you hope to gain from taking part in aquatic therapy?   *
Once you submit this form, we will reach out to you within 2 business days via your preferred contact method (phone or email) to set up an appointment.  

During this time, we will collect a little more information and set up your first Aquatic Therapy session.  

We look forward to working with you and helping you towards your goals!
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