Request an Appointment at Jersey Rehab Need to book an appointment? Please take a moment to fill out the form below and we will contact you as soon as possible to confirm your appointment. Full Name: Please type your full name. E-mail: Invalid email address. Phone: Invalid Input Requested Date: Invalid Input Requested Time: Select a time...9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM 1:30 PM 2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PMInvalid Input Reason: Invalid Input Invalid Input Please note that your appointment is not finalized until we contact you to confirm.