Contact Us

Commitment Physical Therapy
11741 Southwest Highway
Palos Heights, IL 60463
Phone: (708) 361-8052
Fax: (708) 361-8053

Dr. Naglaa's Email: Naglaa@ Commitmentpt.com

Eyad's Email: Eyad@ Commitmentpt.com

Office Email: info@ commitmentpt.com

Handicap Accessible

Hours of Operation

Monday thru Friday 9am - 5pm.
Extended and weekend hours available by appointment.

Contact Patient Request

Contact Patient Request

* Denotes Required Fields:

Who is making the appointment request? *
If you selected "Other", please specify:
Date * / MM / DD YYYY
Patient Name: * First Last
Your Name if Different from the Patient:
Home Phone: * - (###) - ### ####
Best Time to Reach You at this Number:
Email
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
DOB: / MM / DD YYYY
Gender: Male Female
Primary Insurance Name:
ID#:
What type of appointment are you requesting today?
If you selected "Other", please specify:
Is the patient currently receiving rehabilitation care? Yes No
Please List Your Questions or Concerns:
MD Name: First Last
MD Phone: - (###) - ### ####
How did you hear about Commitment Physical Therapy?