First Name
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Last Name
*
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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What concerns you most that makes you want to sample Physical Therapy?
Serious injury, such as a broken bone or head trauma
Loss of independence and potential need for long term assistance
Fear of a fall happening again, leading to reduced confidence and activity
Complications from existing medical condition that could be worsened by a fall
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What does it stop you from doing?
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How long have you 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)
Best time for a call back?
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Through The Day
After 5pm
Anytime
Email
*
Phone
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Yes, Request my FREE Call Back!