Pre-Visit Paperwork

Please complete the form below PRIOR to your visit

First name*

Last name*

Birthday*

Month

Day

Year

Single choice*

Medicare

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Address*

Phone*

Goals/Reason for Interventions

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone Number*

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A Well Being

Lincoln, Nebraska

Dr. Casey travels to YOU

Visits by appointment only.

Please or to schedule.

The initial consultation is FREE!

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A Well Being is a concierge mobile physical therapy and wellness service prioritizing direct prophylactic healthcare for musculoskeletal conditions, balance and fall prevention, pain management, and gait training.

MEDICAL DISCLAIMER:
The information on this website is intended for instruction and informational purposes only. The authors are not responsible for any harm or injury that may result. Consult with a physician before undertaking any information contained on this website. No guarantees of specific results are expressly made or implied on this website.

MAILING ADDRESS:

8337 Ryley Lane

Lincoln, NE 68512

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