Client Application Form

Which best describes what you’re looking for?

Personalized guidance and accountability

A structured plan with professional oversight

A quick fix

Which level of support feels most appropriate for you right now?

Regular check-ins, feedback, and progression with my PT

An initial plan with periodic guidance as needed

Minimal support—I prefer to manage things myself

My@HomePT is a high-touch virtual physical therapy program that requires active participation and follow-through. Does this align with what you’re looking for?

Yes

No

How did you hear about My@HomePT?

Social media

Referral

Website

Other

My@HomePT

Doctor Led Physical Therapy

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