Appointment Request

Contact Appointment Request Appointment Change Request

Senior couple outside
Please complete the following information to make a request for an Initial Examination. Our patient coordinator will call you within 1-2 business days. All requests made Friday afternoon will be addressed on Monday. Please review updated clinic hours/closures on Google/Yelp as this may affect callback response time.

Name*
First Last
Phone*
Email*
Date of Birth*
Preferred Days*
- Monday
- Wednesday
- Thursday
- Friday
Preferred Time of Day*
- Morning (8am - 11:30am)
- Afternoon (12pm - 4pm)
Insurance Type*
Insurance ID #*
Side of body
- Left
- Right
- Both
Body Region*
- Hip
- Knee
- Foot/Ankle
- Hand/Wrist
- Elbow/Shoulder
- Neck/Upper Back
- Mid/Lower Back
Surgery Type and Date of Surgery (if applicable)
Full Name of Referring Physician
Image of Prescription (if available)
Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 10 MB.
Comments or Questions
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Location

194 Francisco Lane Suite 104
Fremont, CA 94539
P: (510) 656-3777
F: (510) 656-3750
Front desk email: frontdesk.ESPT@gmail.com

Quick Links

Make a Payment
Policies
Billing & Insurance
Undergraduate Internship Program
Graduate Internship Program
Request an Appointment
Change/Cancel Appointment

Hours

Monday, Wednesday, Thursday, Friday: 8am – 5pm*

*Office closed daily from 1-2pm
Last appointment one hour before closing
Closed: Tuesday, Saturday, Sunday