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 physical therapy?
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Not knowing what's wrong
Spinal curve progressing
You want to avoid depending upon painkillers to ease pain
The risk of facing dangerous surgery due to chronic pain
Posture is getting worse
The pain getting worse
Losing mobility or independence due to chronic pain
Not being able to exercise
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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)
What would be the one thing you would like us to achieve for you?
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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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Phone
*
Email
*
Which would be preferred clinic to visit?
*
Lehi, UT
St George, UT
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