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Two minutes · No referral needed

Physical therapy assessment

Tell us what hurts and what you want to get back to. Our matching team reads every answer and proposes a licensed physical therapist in the network who fits. You hear back, usually within one business day. Free, with no obligation.

Step 1 of 8Where is the problem?

Pick every area that applies. If it is hard to pin down, choose the closest and explain later.

Which part of your body needs help?

Select all that apply

Which side? (optional)
Step 2 of 8Where should we send your match?

So we can send your match. A person reads your answers, and you hear from us or from the therapist we match you with, usually within one business day. If the patient is under 18, a parent or legal guardian must complete this form.

Best way to reach you
Step 3 of 8How did it start?
What best describes how this began?
Is a surgery planned? (optional)
How long has it been going on?
Step 4 of 8How much is it affecting you?
Pain or discomfort on a typical day

0 is none, 10 is the worst you can imagine

At its worst in the past week (optional)
What is it getting in the way of?

Select all that apply

Step 5 of 8A quick safety check

Physical therapists screen for a few symptoms that need a physician first. Your answers help us point you to the right care, which is sometimes not physical therapy.

Are you experiencing any of these?

Select any that apply

Step 6 of 8Care so far
Has anyone looked at this yet? (optional)

Select all that apply

Have you had an X-ray or MRI for it? (optional)
Do you have a referral or prescription for physical therapy?

You do not need one to start. Indiana allows physical therapy without a referral for the first 42 days.

Step 7 of 8What would a win look like?
What do you most want from physical therapy?

Select all that apply

Step 8 of 8Payment and scheduling
How do you expect to pay for care?

Before you book, we check which therapists in the network work with your plan.

So we can confirm you are close enough for regular visits.

When could you come in?

Select all that could work

How soon do you want to start?
Do you have a preference for your therapist? (optional)

Optional. We match on clinical fit first.

Optional. Please do not include Social Security or insurance ID numbers.

Your answers go to the matching team and to the one therapist we match you with, so their office can prepare for your call. This questionnaire is a screening tool. It is not a diagnosis and it does not create a patient relationship; that begins with the therapist at your first visit. Privacy.

Would you rather talk? Call (888) 353-9975 or request a call back. If you think you are having a medical emergency, call 911.

What happens next

After you hit send

  1. We read it properly

    A person on the matching team reads what you wrote before anyone picks up the phone, so the conversation starts from your situation, not from a script.

  2. We propose a therapist

    An independent, licensed physical therapist in the network whose clinical focus, schedule and coverage fit you. If it is not right, ask for another. If physical therapy is not the answer, we say so.

  3. Their office confirms your benefits

    Usually within one business day, the way you asked to be reached: what your plan covers and what a visit will cost, before you book. How cost and insurance work.

  4. You book your evaluation

    About an hour, one-on-one, in the therapist’s private suite at Carmel City Center. What your first visit looks like.

About the assessment

Is the questionnaire a diagnosis?

No. It is a short screening questionnaire that tells our matching team, and then your therapist, enough to have a useful first conversation with you. A diagnosis needs an in-person examination by the therapist.

What happens after I send it?

Our matching team reads your answers and proposes a physical therapist in the network whose focus, schedule and coverage fit. You hear from us or from that therapist’s office, usually within one business day, to talk it through, confirm benefits and offer appointment times. If the match is not right, ask for another.

Does it cost anything or commit me to anything?

No. The questionnaire and the first conversation are free and there is no obligation to book with anyone.

Who sees my answers?

Our matching team, the one therapist we match you with so their office can prepare for your call, and the services that deliver and store the form for us (website hosting, a backup database and email delivery). We never sell your answers or share them with advertisers. Privacy.

Page reviewed By the Monon Therapy Collective editorial team