Patient Referral Rewards Program

Do you have a family member, friend or co-worker that has pain or an injury?

At Function Physical Therapy we believe the best way to spread the word about what we are doing here to help people is by personal recommendations from patients like you.  We hope you had a good experience with us and value your partnership in increasing awareness of Function Physical Therapy in the community.  As a way to say thank you and show our appreciation, we have developed our Referral Rewards Program.

Here is How it Works:

  • Refer (1) family member, friend or co-worker to us for physical therapy and receive a gift from us.  To help us know how to contact you for the reward, have your friend/family member bring one of our referral cards completed to their first visit or simply fill out this form and we will contact you once they have attended their appointment.

Your word of mouth to family, friends and co-workers is the greatest compliment to us and will help spread the word about Function Physical Therapy in the community.  We value your support and greatly appreciate making Function Physical Therapy your provider of choice!



Friend/Family Member Name *
Friend/Family Member Name
Phone Number *
Phone Number
Referred By *
Referred By
Phone Number *
Phone Number