First Name
*
Last Name
*
Email
*
Phone
*
Where does it hurt or what is it effecting?
*
Where does it hurt or what is it effecting?
Lower Back
Knee
Shoulder/Neck
Ankle/Foot
Hips
TMJ
Balance and Mobility
Parkinson's
Golf
Pickleball
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How long have you suffered or worried?
*
Haven't - this is prevention not cure
1-2 weeks
2-4 weeks
1-3 months
Long enough
Seems like too long (years)
Please tell us how long you have suffered or worried*
What concerns you most?
*
What concerns you most?
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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What does it stop you from doing?
*
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