First Name
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Last Name
*
Primary reason for wanting to sample physical therapy?
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What does it stop you from doing?
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How long have you suffered or worried?
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I haven't - this is prevention not a cure
1-2 weeks
2-4 weeks
1-3 months
Long enough
Seems like too long (years)
What would be the one thing you would like us to achieve for you?
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What would be the one thing you would like us to achieve for you?
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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