First Name
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Last Name
*
Email
*
Phone
*
What concerns you most?
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Not knowing what's wrong
You want to avoid depending upon painkillers to ease pain
Losing mobility or independence due to chronic pain
The risk of facing dangerous surgery due to chronic pain
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How Long Have Your Suffered Or Worried?
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Haven't - this is prevention not cure
1-2 weeks
2-4 weeks
1-3 months
Long enough
Seems like too long (years)
Main goal of using our specialist service
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Ease pain
Ease stiffness
Get active
Stay active
Avoid painkillers
Find out what's wrong
Stay healthy and get fixed before it gets worse
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Where Does it Hurt?
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Back Pain
Knee Pain
Neck & Shoulder Pain
Sports Injury
TMJ Pain
Pelvic Floor
Foot pain
headaches and migraines
Hip Pain
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What does it stop you from doing?
*
How did you hear about us?
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WOM/Patient Referral
Google
Facebook/Social
Doctor Referral
Community Event
Other
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