Complete Appointment Request Form First Name Middle Name Last Name Email Address Date Of Birth Contact Number Do you have Insurance? Yes / No; Yes No Name of Current Insurance Company Policy/Member Number Group Number Desired Office Location --Please Select-- Goldson Spine Plantation Goldson Spine Pembroke Pines Goldson Spine Aventura Goldson Spine North Lauderdale Goldson Spine Port Saint Lucie Desired Date for Appointment Desired Time --Please Select-- 8:00am to 8:30am 8:30am to 9:00am 9:00am to 9:30am 9:30am to 10:00am 10:00am to 10:30am 10:30am to 11:00am 11:00am to 11:30am 11:30am to 12:00pm 12:00pm to 12:30pm 12:30pm to 1:00pm 1:00pm to 1:30pm 1:30pm to 2:00pm 2:00pm to 2:30pm 2:30pm to 3:00pm 3:00pm to 3:30pm 3:30pm to 4:00pm 4:00pm to 4:30pm 4:30pm to 5:00pm 5:00pm to 5:30pm Are you a repeat patient? Yes / No; Yes No If yes, please state the purpose of your previous visit The Location Visited --Please Select-- First Visit Goldson Spine Plantation Goldson Spine Pembroke Pines Goldson Spine Aventura Goldson Spine North Lauderdale Goldson Spine Port Saint Lucie Reasons for Current Visit --Please Select-- Auto Accident Maintenance Care Back Pain Neck Pain Shoulder Pain Low Back Pain Headache Muscle Stiffness Joint Pain Other If other, please list reason below Meet our Doctors Dr. Fidel S. Goldson Jr., DC, PT Chiropractor Doctor Fidel Goldson, Jr. is a licensed physical therapist and chiropractic physician in South Florida... Dr. Thiema Goldson, DMFT, LMFT Licensed Family Therapist Dr. Thiema Goldson received her Bachelor’s degree in Journalism in 2006 from the University of North Texas. Upon the realization that she possessed more than one passion, Dr. Thiema... Dr. Brittany Goldson DPT, MBA Physical Therapy Director Dr. Brittany Goldson is the Physical Therapy director of Goldson Spine Rehabilitation Center located in South Florida... Dr. Koi Ibrahim DC. MS. Dr. Koi Ibrahim DC. MS. Dr. Koi is from Charlotte, NC, but has roots from Sierra Leone, West Africa. Dr. Koi holds a Bachelors in Exercise Science with a concentration in Health and Fitness... Toni-Ann Leys, CCPA CCPA Toni-Ann Leys has a dual role at Goldson Spine North Lauderdale as a Certified Chiropractic...
