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Vicki Sims, PT, CHT
Gainesville Physical Therapy
1296 Sims Street, Suite A
Gainesville, GA 30501
Phone: 770.297.1700
sijd@gainesvillept.com
www.gainesvillept.com

David Mesnick, PT, cMDT
Body Mechanics Physical Therapy
550 Peachtree Street, Suite 1760
Atlanta, Georgia 30308
Phone: 404.817.0734
dmesnick@bodymechanicsatl.com
www.bodymechanicsatl.com

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Schedule A Phone Consultation

Please fill out the form below to contact someone from the SI Department at GPT for your scheduled phone consulation. Phone consults are $50/per 30 minutes. After you submit the form below, someone from the SI Department at GPT will call you to schedule a time for a phone consultation.

* = Required Fields
Date:
*Name:
DOB:
Mailing Address:
*Email Address:
*Home Phone:
Cell Phone:
Brief Description of Injury / Onset of Symptoms:
Symptoms:
Positions / Activities that Worsen Symptoms:
Positions / Activities that Lessen Symptoms:
Related Medical History:
Condition of General Health / Past Medical History That Would be Important for Us to Know:
Medications:
Past Surgeries:
Please list any tests you've had done:
Injections (Location & Type):
Physical Therapy (Type, Duration, Benefit):
Chiropractic Care (Type, Duration, Benefit):

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