First Name
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Phone
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Email
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Where does it hurt?
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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)
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