Request a Peer Visit

Living In Motion 359 Days A Year... because you get 6 days to be a couch potato!

Living In Motion 359 Days A Year

We have 16 peer visitors who have been certified through the Amputee Coalition. If you would like to request a peer visit for yourself or someone else, please complete and submit the following form or send an email to livinginmotion359@gmail.com:

Name*
First Last
Email*
Phone
Amputation Level
Date of Amputation
Age
What do you hope to get out of a peer visit?
Is there anything else you'd like to tell us about yourself?

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