We’re here to help. Ready to get started?Phone(603) 931-0242Emailhello@connectivewellnessco.com REQUEST INITIAL CONSULT Initial Consult Name * First Name Last Name Phone * (###) ### #### Email * How would you prefer we contact you? * Phone Text Email Which diagnosis (either confirmed or suspected) best describes your primary reason for seeking physical therapy? Hypermobile Ehlers-Danlos Syndrome (EDS) Other Ehlers-Danlos Syndrome (EDS) Hypermobility Spectrum Disorder (HSD) Fibromyalgia Chronic Pain Syndrome (CPS) Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Autoimmune Disease Dysautonomia, such as POTS Mast Cell Activation Syndrome (MCAS) Other Please briefly tell us about your medical history and why you're seeking physical therapy. * Please tell us your typical availability for an appointment at our Amherst, NH clinic. (Check all that apply.) * Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Weekend Availability Only Our comprehensive lifestyle medicine clinic will be offering additional services beginning fall 2024. Which, if any, are of interest to you? (Check all that apply.) * Massage Therapy Chiropractic Care IV Hydration Infrared/Salt Sauna Nutrition Coaching Primary Care Diagnostics Lifestyle Coaching Medical Pain Management Individual Mental Health Services Group Therapy/Support Group Online Membership Patient Advocacy Thank you for your interest in scheduling an initial consult with Dr. Jason Cole at Connective Wellness in Amherst, New Hampshire. Expect to receive a response via your preferred communication method within 48 hours. We look forward to working with you!Lauren & Jason
