OSS Contact Us Form

1

Please enter your name* This field is required.

First Name

Last Name

2

Please enter your email address* This field is required.

example@example.com

3

(Optional) Phone NumberPlease enter the best phone number to reach you if necessary

Please enter a valid phone number.

4

May we contact you by text message (SMS) if necessary?If you indicate "Yes", you consent to receive SMS messages from us. Standard messaging rates may apply.

Yes

No

5

I would like to...* This field is required.

Make, change, or ask a question about an appointment

Share feedback

Contact the billing office

Contact the Medical Records Custodian

Find out more about jobs at OSS

Find out more about PT/OT student clinical affiliations

Something else

6

Are you a new or existing patient?* This field is required.

I am a New Patient and would like to schedule an appointment

I am an existing patient and I would like to change or cancel my appointment

8

How may we help you?* This field is required.

10

We love feedback! Please share your story with us.* This field is required.

11

May we share your feedback publicly?* This field is required.If yes, we have your permission to post all or part of your feedback to our website, social media accounts or other marketing materials.

YESNO

12

Please verify that you are human* This field is required.