Make Appointment

New patients are invited to use the form below to submit details regarding their contact information and insurance provider. Please ensure that all information will be kept confidential by the office staff at Gray Physical Therapy. Please call our office at (207) 657-5600 with any questions.

Please note: By submitting this form, you are just requesting an appointment. Submission of this form does not constitute a booking. Upon receiving your request, someone from our office will be in contact with you to schedule your appointment.

Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Who are we billing?*
Policy Number*
Email*
Phone*
Name of Insurance*
What is the best time and day to schedule your appointment?
Comments
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205 Portland Rd
PO Box 1047, Gray, Maine 04039

Tel: (207) 657-5600
Fax: (855)-464-0106
office@grayptcenter.com

Proudly Serving The Following Communities:

Gray, New Gloucester, Raymond, Cumberland, Windham, North Yarmouth, Pownal and beyond

205 Portland Rd
PO Box 1047, Gray, Maine 04039

Tel: (207) 657-5600
Fax: (855)-464-0106
office@grayptcenter.com

Our Affiliate:
Premier Physical Therapy
316 Portland Rd
Bridgton, Maine 04009

Tel: (207) 647-2727

Proudly Serving The Following Communities:
Gray, New Gloucester, Raymond, Cumberland, North Yarmouth, Pownal