First Name
*
Last Name
*
Primary reason for wanting to sample Physical Therapy
*
What does it stop you from doing?
*
What concerns you most that makes you want to sample physiotherapy?
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What concerns you most that makes you want to sample physiotherapy?
Not knowing what's wrong
You want to avoid depending upon painkillers to help the pain
Losing mobility or independence due to chronic pain
The risk of facing dangerous surgery
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How Long Have You Suffered Or Worried?
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Not suffering - this is prevention not cure
1-4 weeks
1-3 months
3-6 months
More than 6 months
Too long (years)
What's the one thing you would like us to help you achieve?
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What's the one thing you would like us to help you achieve?
Lower pain
Improve stiffness
Get active
Stay active
Avoid painkillers
Find out what's wrong
Stay healthy and get fixed before it gets worse
Other
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Phone
*
Email
*
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