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To Book Your Appointment Call
519-304-5007

106-265 King George Rd. Brantford, ON. N3R 6Y1

Apply for a Free “Discovery” Visit (to See if You Like it…)

Please Watch the Video and Then Fill Out This Form to Apply for Your Free Discovery Session. Hurry: These sessions are limited and given away on a first-come, first-served basis...

Step 1 About you
Step 2 Your Pain/Injury
Step 3 Finish!

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Please Enter Your First Name *

Primary reason for wanting to start with a Discovery Session? *

I want to learn more about what you do and my options for care
I would like to know if you can help me figure out what is causing my pain
I'm not sure who I should see and talking to the doctor first would help me decide

What Concerns You Most? *

Where Does It Hurt? *

What Does It STOP You From Doing? *

How Long Have You Suffered or Worried? *

I haven’t - looking for prevention
A few days
1-2 weeks
2-4 weeks
1-3 months
A year
Long enough
Too long (years)

What Is the Main Goal You Would Like Us to Help You Achieve? *

Please tell us where to contact you with the outcome of the Free Discovery Visit application:

Phone Number *

Best Email *

Then please check your email account in the next 10 minutes for a personal reply from the Brant Wellness & Rehab team.

All of your details are 100% safe with us.

106-265 King George Rd. Brantford, ON. N3R 6Y1
519-304-5007
dr.spenser@brantwellnessandrehab.com

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