Dallas Physical Therapy Registration

Please complete all fields on this form to ensure your registration. ALL sessions meet from 10:00 a.m.- 12noon.

Note: You will not receive an email confirmation upon completion of the form.

* required fields

Personal Information

First Name

Last Name

Address

City

State

Zip

Phone

Physical Therapy Session Information

Please register me for the information session on

I plan to enroll for

Number attending

Current School