Office Hours

By appointment only. OMPT Specialists’
office hours are subject to change:

Mon - Fri 7:00am - 7:00pm
Sat* 8:30am - 12:30pm
* Open every other Saturday

Call to schedule an appointment: 248-353-1234

Please fill out this form and we will contact you shortly.

You may also download a PDF of this form and mail it to:

OMPT Specialists
29255 Northwestern Hwy.
Suite 300
Southfield, MI 48034

First Name:
Last Name:
Address:
City:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Email
Best way to reach you:
Birthdate
Referring Physician: Phone:
Where does it hurt?
Have you had surgery?

Is this an auto related injury?
Is this a work related injury?
Date of injury:
Claim #:
Contract #:
How did you hear about us?: