Free Discovery Session Request (Online Video Call)

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Thank you for your interest in working with Deconstruct Health to get you on track to recovery!

In order for us to make the most out of your discovery visit, please answer the questions below and we will get back to you within 1-3 business days to schedule your appointment.

电子邮件地址 *

Full Name *

Age *

Pronouns

ex. He/Him/His, She/Her/Hers, They/Them/Theirs, etc.

Phone Number *

Write out phone number using only digits.( Ex. 3104444444)

Which City, State are you located in? *

How did you find out about us? *

What service(s) are you interested in? *

Mind Body Pain Recovery Program

Orthopedic/Sports Injury Physical Therapy (Muscle, joint, tendon, ligament or nerve pain/injury)

Pelvic Floor Physical Therapy (Pelvic pain, Endometriosis, Bladder Pain, Vaginal pain, Vulvar pain, Clitoral Pain, Testicular pain, Penile pain, Pain with sex, Painful orgasms/ejaculation, Urinary/Bowel leakage, Constipation, Overactive Bladder, Difficulty with urination, etc)

Chronic Pain Physical Therapy (CRPS, Phantom limb pain, Fibromyalgia, Chronic pelvic pain conditions, Chronic low back pain, Sciatica, etc)

Gender Affirming Physical Therapy

Retrain and Know Pain Coaching

Personal Training/Exercise Programming

必填

Preferred Day(s) and Time(s) *

Monday

Wednesday

Friday

Morning (8am-12pm)

Afternoon (1pm-6pm)

必填

Please provide a brief summary of the problem you are looking to discuss. *

What have you tried to address this problem?

How effective were the treatments/providers at addressing the problem in the short term?

How effective were the treatments/providers at addressing the problem in the long term?

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