First Name
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Last Name
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Primary reason for wanting to sample Physical Therapy?
*
What does it stop you from doing?
*
What concerns you most?
What concerns you most?
The pain
Fear of not being able to keep active
Not knowing whats wrong
Avoiding painkillers
No sign of improvement
Future ill health
Difficulty with intimacy/conception
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How long have you suffered or worried?
A few days
1-2 weeks
2-4 weeks
1-3 months
Seems like too long (years)
Main goal of using our specialist service
*
Main goal of using our specialist service
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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Email
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Phone
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