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Request an Appointment for Orthopedic Services

To request an orthopedic services appointment for your bone and joint pain, injury, or concern, complete the secure online appointment request form below, or call 1-877-CK-MOTION (1-877-256-6846).

A referral counselor will call you within two business days (48 hours) to schedule an appointment.

If this is an emergency, please call 911 or go to your nearest hospital’s emergency room.
Please fill out the following as completely as possible.
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Patient Information

Referring Physician Information

* Treatment Required For

Injury/Illness Information

Any previous treatment?
Was surgery recommended?

Orthopedic Practices

Premier Orthopedics, Orthopedic Associates

Crozer Medical Plaza
300 Evergreen Drive
Suite 200
Glen Mills, PA 19342

Crozer-Chester Medical Center
One Medical Center Blvd.
POB II, Suite 234
Upland, PA 19013

Media Medical Plaza
200 East State Street
Suite 108
Media, PA 19063

Premier Orthopedics, Sports and Spine Rehabilitation

525 West Chester Pike
Suite 203
Havertown, PA 19083

Premier Orthopedics, Liberty

1 Bartol Avenue
Suite 100
Ridley Park, PA  19078

Premier Orthopedics, Llanerch Orthopedics

510 West Darby Road
Havertown, PA 19083

Healthplex® Sports Medicine Institute

196 West Sproul Road
Healthplex Pavilion I, Suite 110
Springfield, PA 19064

Premier Orthopedics, Surgical Orthopedic Associates

2004 Sproul Road
1st Floor
Broomall, PA 19008