First Name
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Last Name
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Email
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Phone
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Where Does it Hurt?
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Where Does it Hurt?
Back Pain
Neck & Shoulder Pain
Foot Pain
Knee Pain
Other
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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
Main goal of using our specialist service
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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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What does it stop you from doing?
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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 help the pain
Losing mobility or independence due to chronic pain
The risk of facing dangerous surgery
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