Community Wellness | Rebound

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Phone: 662-842-2100

Email: reboundtupelo@comcast.net

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COMMUNITY WELLNESS

KNOW BEFORE YOU GO

An opportunity to get you ready for the gym.
Receive a tailored program to meet your needs.
"Check-Ins" available to alter program and see progress.
At home or at gym options for exercise.

WELLNESS OPPORTUNITY AT REBOUND

Purchase 18 visits for $100.
- NOT treatment with a provider but can be performed independently.
Includes access to gym and equipment.
Can include a personalized plan from one of our physical therapists that includes one-on-one instructions the first time you come. (Additional Charge)

GET TO KNOW YOU FORM

Help your Physical Therapist get to know you and your goals better!

Email*

Phone*

First name

Last name*

What is your age?*

What are your personal fitness goals?*

Do you currently exercise? If so, how often, and what kind?*

Have you stopped exercising due to pain/discomfort in a particular area? If so, where?*

Have you been reluctant to start exercising? If so, why? Select all that apply.*

Recent Surgery

Health Conditions

Unsure Where to Start

Gym Intimidation

Other

Do you have health conditions or concerns? Please list below.*

Which exercise program areas are you interested in receiving guidance?*

Upper Body

Lower Body

Full Body

Other

What is you Exercise Management Preference following this program?*

Join a Gym

Manage Exercise Program at Home

Hybrid (Home & Gym)

Other

Would you be interested in "Check-Ins" with your PT after starting the program?*

Absolutely!

No Thanks

I grant Rebound Physical Therapy permission to contact me for a "Check-In" following my initial PT visit.*

Yes

No

Further Comments/Concerns I want my Physical Therapist to know.

© 2025 by Rebound Physical Therapy

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