5101 North Executive Drive

Peoria, IL 61614


Phone (Call or Text): 309-839-8631

Fax: 855-579-3536

Billing: 309-256-8312

Email: lisenbypt@gmail.com

Please fill out one of the secure forms below that best fits your reason for physical therapy care. 

Female Patients

Male Patients

Pediatric Patients

Pelvic 

for Pelvic Health conditions such as Incontinence, Post-partum conditions, Pelvic Pain, Pain with Intercourse, or Prolapse.


Orthopedic

​for Orthopedic conditions such as Back or Neck Pain, Dizziness and Balance Disorders, Pregnancy, or Joint or Muscle Pain.


Pelvic 

for Pelvic Health conditions such as Chronic Prostatitis, Incontinence, Post-Prostatectomy Pain, or Interstitial Cystitis.

Orthopedic

for Orthopedic conditions such as Back or Neck

Pain, Dizziness and Balance Disorders, or Joint or Muscle Pain.

Medical History;

for all Pediatric health conditions such as ​Bed Wetting, General Orthopedic Pain/Strains, Constipation, Bladder Conditions, Postural Abnormalities, Sports Injuries.



​New Patient Forms


Please fill out these forms prior to your appointment. If you are unable to complete these forms beforehand, please come 15 minutes early to complete them in office, before your appointment. Failure to do so, may result in an incomplete initial exam and delay your treatment progression.


Also, please bring your photo ID and insurance card(s) that we will be billing to your appointment.