{"id":17,"date":"2017-07-10T15:21:44","date_gmt":"2017-07-10T22:21:44","guid":{"rendered":"http:\/\/motipt.com\/?page_id=17"},"modified":"2019-10-02T15:19:53","modified_gmt":"2019-10-02T22:19:53","slug":"appointments","status":"publish","type":"page","link":"https:\/\/motipt.com\/appointments\/","title":{"rendered":"Appointments"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Progress starts with your initial evaluation and grows through consistent follow-up visits. Reach out to schedule  your physical therapy Plan of Care when you\u2019re ready to stay the course and reach your goals.\r\nIf you are ready to commit to physical therapy, please fill out and submit the form below. One of our administrators will be in touch shortly to assist you with scheduling. Thank you!<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/wp-json\/wp\/v2\/pages\/17' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_2_10\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_10'>\n                            \n                            <span id='input_2_10_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.3' id='input_2_10_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_10_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_10_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.6' id='input_2_10_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_10_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_17\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_17'>Preferred Pronouns<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_2\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_2'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_2' id='input_2_2' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_2_3' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_14'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_2_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are You A New Patient?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_12'>\n\t\t\t<li class='gchoice gchoice_2_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Yes'  id='choice_2_12_0'    \/>\n\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='No'  id='choice_2_12_1'    \/>\n\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >At what location would you like to make an appointment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_15'>\n\t\t\t<li class='gchoice gchoice_2_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='Los Feliz'  id='choice_2_15_0'    \/>\n\t\t\t\t<label for='choice_2_15_0' id='label_2_15_0' class='gform-field-label gform-field-label--type-inline'>Los Feliz<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='Highland Park'  id='choice_2_15_1'    \/>\n\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline'>Highland Park<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_15_2'>\n\t\t\t\t<input name='input_15' type='radio' value='Playa Vista'  id='choice_2_15_2'    \/>\n\t\t\t\t<label for='choice_2_15_2' id='label_2_15_2' class='gform-field-label gform-field-label--type-inline'>Playa Vista<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_15_3'>\n\t\t\t\t<input name='input_15' type='radio' value='Mid Wilshire'  id='choice_2_15_3'    \/>\n\t\t\t\t<label for='choice_2_15_3' id='label_2_15_3' class='gform-field-label gform-field-label--type-inline'>Mid Wilshire<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Would you be open to a condensed Initial Evaluation, if it enables you to start receiving care sooner? Typically, Evals are scheduled for a full hour 1-on-1 with the Therapist. However, if it is appropriate for your injury, we could schedule a condensed Initial Evaluation (similar to your Follow Up visits) where you would spend a designated 30 minutes 1-on-1 with your Therapist, then you would complete the remainder of your visit under the supervision of a PT Aide.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_35'>\n\t\t\t<li class='gchoice gchoice_2_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='Yes'  id='choice_2_35_0'    \/>\n\t\t\t\t<label for='choice_2_35_0' id='label_2_35_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='No'  id='choice_2_35_1'    \/>\n\t\t\t\t<label for='choice_2_35_1' id='label_2_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >(OPTIONAL) Our Los Feliz clinic has the greatest demand. If you can get in sooner (likely by several weeks) at another location, and you are interested, please designate which other locations would work for you:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_29'>\n\t\t\t<li class='gchoice gchoice_2_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='Highland Park'  id='choice_2_29_0'    \/>\n\t\t\t\t<label for='choice_2_29_0' id='label_2_29_0' class='gform-field-label gform-field-label--type-inline'>Highland Park<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='Playa Vista'  id='choice_2_29_1'    \/>\n\t\t\t\t<label for='choice_2_29_1' id='label_2_29_1' class='gform-field-label gform-field-label--type-inline'>Playa Vista<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_29_2'>\n\t\t\t\t<input name='input_29' type='radio' value='Mid Wilshire'  id='choice_2_29_2'    \/>\n\t\t\t\t<label for='choice_2_29_2' id='label_2_29_2' class='gform-field-label gform-field-label--type-inline'>Mid Wilshire<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What kind of appointment are you interested in?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_28'>\n\t\t\t<li class='gchoice gchoice_2_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='Physical Therapy'  id='choice_2_28_0'    \/>\n\t\t\t\t<label for='choice_2_28_0' id='label_2_28_0' class='gform-field-label gform-field-label--type-inline'>Physical Therapy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='Personal Training'  id='choice_2_28_1'    \/>\n\t\t\t\t<label for='choice_2_28_1' id='label_2_28_1' class='gform-field-label gform-field-label--type-inline'>Personal Training<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are your Physical Therapy needs related to a recent or upcoming surgery?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_30'>\n\t\t\t<li class='gchoice gchoice_2_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='Yes'  id='choice_2_30_0'    \/>\n\t\t\t\t<label for='choice_2_30_0' id='label_2_30_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='No'  id='choice_2_30_1'    \/>\n\t\t\t\t<label for='choice_2_30_1' id='label_2_30_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_34'>When was your surgery completed? or for when is it scheduled?<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_2_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_22\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_22'>Did your doctor refer you to MOTI? What is your doctor&#039;s name?<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_2_22' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How did you hear about us?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_23'>\n\t\t\t<li class='gchoice gchoice_2_23_0'>\n\t\t\t\t<input name='input_23' type='radio' value='Doctor'  id='choice_2_23_0'    \/>\n\t\t\t\t<label for='choice_2_23_0' id='label_2_23_0' class='gform-field-label gform-field-label--type-inline'>Doctor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_1'>\n\t\t\t\t<input name='input_23' type='radio' value='Family or Friend'  id='choice_2_23_1'    \/>\n\t\t\t\t<label for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline'>Family or Friend<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_2'>\n\t\t\t\t<input name='input_23' type='radio' value='Google search'  id='choice_2_23_2'    \/>\n\t\t\t\t<label for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline'>Google search<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_3'>\n\t\t\t\t<input name='input_23' type='radio' value='Yelp search'  id='choice_2_23_3'    \/>\n\t\t\t\t<label for='choice_2_23_3' id='label_2_23_3' class='gform-field-label gform-field-label--type-inline'>Yelp search<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_4'>\n\t\t\t\t<input name='input_23' type='radio' value='Insurance Company'  id='choice_2_23_4'    \/>\n\t\t\t\t<label for='choice_2_23_4' id='label_2_23_4' class='gform-field-label gform-field-label--type-inline'>Insurance Company<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_5'>\n\t\t\t\t<input name='input_23' type='radio' value='Saw Signs'  id='choice_2_23_5'    \/>\n\t\t\t\t<label for='choice_2_23_5' id='label_2_23_5' class='gform-field-label gform-field-label--type-inline'>Saw Signs<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_6'>\n\t\t\t\t<input name='input_23' type='radio' value='Social Media'  id='choice_2_23_6'    \/>\n\t\t\t\t<label for='choice_2_23_6' id='label_2_23_6' class='gform-field-label gform-field-label--type-inline'>Social Media<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_23_7'>\n\t\t\t\t<input name='input_23' type='radio' value='Brochure'  id='choice_2_23_7'    \/>\n\t\t\t\t<label for='choice_2_23_7' id='label_2_23_7' class='gform-field-label gform-field-label--type-inline'>Brochure<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What kind of medical insurance do you have?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_13'>\n\t\t\t<li class='gchoice gchoice_2_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Aetna'  id='choice_2_13_0'    \/>\n\t\t\t\t<label for='choice_2_13_0' id='label_2_13_0' class='gform-field-label gform-field-label--type-inline'>Aetna<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='Anthem Blue Cross'  id='choice_2_13_1'    \/>\n\t\t\t\t<label for='choice_2_13_1' id='label_2_13_1' class='gform-field-label gform-field-label--type-inline'>Anthem Blue Cross<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='Blue Shield'  id='choice_2_13_2'    \/>\n\t\t\t\t<label for='choice_2_13_2' id='label_2_13_2' class='gform-field-label gform-field-label--type-inline'>Blue Shield<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='Medicare'  id='choice_2_13_3'    \/>\n\t\t\t\t<label for='choice_2_13_3' id='label_2_13_3' class='gform-field-label gform-field-label--type-inline'>Medicare<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='HealthNet'  id='choice_2_13_4'    \/>\n\t\t\t\t<label for='choice_2_13_4' id='label_2_13_4' class='gform-field-label gform-field-label--type-inline'>HealthNet<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_13_5'>\n\t\t\t\t<input name='input_13' type='radio' 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