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PTA

Jim Ehirim

Physical Therapist Assistant

Practice Location(s): Freehold

Specialty: Physical Therapist Assistant

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First Name*

Last Name*

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Location*

Primary Area of Pain*

Reason for Visit (check all that apply)

Headache/Migraine

Headache/Migraine

Vertigo

Vertigo

Concussion

Concussion

Scoliosis

Scoliosis

Neurological Condition

Neurological Condition

Shoulder Pain

Shoulder Pain

Elbow Pain

Elbow Pain

Knee Pain

Knee Pain

Hip Pain

Hip Pain

Leg Pain

Leg Pain

Neck Pain

Neck Pain

Wrist/Hand Pain

Wrist/Hand Pain

Foot/Ankle Pain

Foot/Ankle Pain

Mid Back Pain

Mid Back Pain

Lower Back Pain - Sciatica

Lower Back Pain - Sciatica

Lower Back Pain - Axial

Lower Back Pain - Axial

Wellness (No Pain)

Wellness (No Pain)

Other Condition

Other Condition

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I acknowledge that information submitted through this form will be sent via email, which is not a secure messaging system. Please refrain from sharing private health information here as we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form. This form is for appointment requests only. To confirm your appointment, a patient advocate will contact you for insurance details, coverage verification, and benefits discussion. No doctor's referral is needed for consultations or treatment. Please note we accept out-of-network payments from many commercial carriers, we are in-network with Medicare, and we do not accept Medicaid. By sharing your phone number, you agree to receive SMS from Alliance Orthopedics. Standard rates apply. For data handling details, visit here. We do not share your mobile info with third parties, except for text messaging originator opt-in data, which remains confidential.*

*In order to confirm an appointment, a patient advocate will reach out to you to gather your insurance information to verify your coverage and go over your benefits one-on-one.

**Please be aware this is an appointment request.

A doctor’s referral is not necessary to see our team for a consultation or to receive treatment.

We accept out of network payments from the commercial carriers, but we do not accept Medicaid.
Aetna, BCBS/Anthem, Cigna, Magnacare, GHI/Emblem, Horizon, Amerihealth, United Healthcare, Meritain, Medicare.

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LOCATIONS:

Six Convenient Locations in New Jersey

Fair Lawn

Bloomfield

Freehold

East Brunswick

Old Bridge

Randolph

Middletown - Coming Summer '24

Union - Coming Fall '2024

Alliance Orthopedics, with offices in New Jersey, is a multidisciplinary practice focused on helping patients and their families get better faster.

The staff consists of highly trained and licensed professionals includes specialists in orthopedic surgery, sports medicine, pain management, chiropractic care, physical therapy, acupuncture, and occupational therapy.

Alliance Orthopedics speaks these languages: English, Hindi, Spanish, Mandarin, Hebrew, Korean & Russian.

Begin your journey to pain free today!

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