Schedule Appointment

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SCHEDULE APPOINTMENT

PLEASE FILL OUT THE BELOW FORM COMPLETELY - THANK YOU

First Name

Email

Type of Injury

Type of Accident * Required

Auto Accident

Slip & Fall Accident

Workplace Accident

Sports Accident

Other

Were you referred by an Attorney * Required

Yes

No

Last Name

Phone Number

Appointment Date Request

Do you need transportation * Required

Yes

No

Have you received treatment already * Required

Yes

No

Do you have insurance * Required

Yes

No

Thank you for submitting, someone will get back to you soon.

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2415 Hollywood Blvd, Hollywood, FL 33020

Phone: (954) 906-PAIN │ Fax: (954) 456-0820 │ Email: premier@mypthc.com

OFFICE HOURS
Monday│Tuesday│Thursday│Friday 9:00am - 7:00pm
Wednesday: 9:00am - 6:00pm
Weekend Appointments Available by Appointment Only

© Copyright 2024 Premier Total Healthcare │www.personalinjurytherapies.com │ All Rights Reserved

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