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Schedule Complimentary Screen

To schedule your complimentary screen, please complete the following form and a customer service specialists will be in touch to confirm your appointment.

Patient Information
Name*
First Last
Phone*
Email*
Address*
State / Province / Region
How did you hear about us?
Is your insurance federally funded (medicare, tricare, etc.)?*
- Yes
- No
Per federal guidelines, beneficiaries of federally funded insurances (e.g.- Medicare and Tricare) are not eligible for complimentary injury screens. However, a Balance and Fall Prevention screen is permitted.
- I would like to receive newsletters and email correspondence from Upstream Rehabilitation.
Email
This field is for validation purposes and should be left unchanged.

Questions?

1-866-577-7342

Let Us Help You

Schedule Complimentary Screen