Initial Appointment Form

top of page

HOME
ABOUT
STAFF
SERVICES
PILATES
MASSAGE
PRODUCTS
TESTIMONIALS
CAREERS
FAQ
MORE

Use tab to navigate through the menu items.

Portal

Request an Appointment

Fill out this form to begin the process of creating your first appointment. We will call to schedule after inputting your information into our system.

First name*

Last name*

I have been a patient at Agile before.

Date of Birth*

Month

Day

Year

Phone*

Email*

Do you have a prescription for PT by a doctor?*

Insurance Type*

Are you the policyholder?*

What is your preferred date and time for the first appointment?*

Month

Day

Year

Time

:HoursMinutes

Anything else you want us to know?

Address:

3125 Blue Lake Drive,

Vestavia, AL 35243

CONTACT

Phone: (205) 969-7887

Fax: (205) 969-7886

Email: info@myagilept.com

THE CLINIC

Hours:

Mon - Thurs: 7:30am - 5:00pm

Fri: 8am -3:00pm

Sat: Closed

Sun: Closed

Consumer information is not shared with third-parties for marketing purposes we collect this information to communicate directly with our clients about their information.

bottom of page