First Name *

Last Name *

Where does it hurt? *

Where does it hurt?

Back Pain
Knee Pain
Neck & Shoulder Pain
Sports Injury
Hip Pain
Foot & Ankle Pain
Headaches
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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
Other
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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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If other, please elaborate:

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)

What does your pain stop you from doing? *

Phone *

Email *

What services are you interested in? *

What services are you interested in?

Physical Therapy
Manual Therapy
Laser Therapy
Dry Needling
Percussion Massage
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