Appointment Request Form

    Use the form below to request a sports physical appointment. The Sports Physical fee is $25 and is due at the time of the appointment. Our office will contact you to confirm scheduling based on appointment availability.

    Our offices are open Monday through Friday from 9am to 6pm. Appointments must be requested at least 2 day(s) in advance. If you are having an emergency please call our office at (330) 726-7404.

    Additional Comments

    Please do not send personal medical or health information via this form. Our office can discuss these matters with you in detail during our telephone conversation with you.

    Yes! Please add me to the Advanced Chiropractic & Rehab, Inc. newsletter list so that I may receive special offers and more.