First Name
What Service Are You Interested In?
Shoulder/Neck Pain
Elbow Pain
Hand/Wrist Pain
Knee/Leg Pain
Instrument Assisted Soft Tissue Mobilization
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What is your ideal day to get started with an appointment?
Monday
Tuesday
Wednesday
Thursday
Friday
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What Is Your Preferred Time For An Appointment?
Anytime During The Day
7 AM - 12 PM
12 PM - 4 PM
After 4 PM
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How Much Time And Attention Do You Prefer?
30 minutes (Silver)
60 minutes (Gold)
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Where does it hurt?
Shoulder/Neck
Elbow
Wrist/Hand
Back
Knees/Legs
Muscle Injury from Sport/Exercise
Not Sure Where It's Coming From
I have Neurological Problems
Other
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What does it stop you from doing?
How Long Have You Suffered?
Haven't—This Is Prevention (Not Cure)
A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Seems Like Too Long (Years)
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What Concerns You Most?
The Pain Getting Worste
Difficulty Moving
Not Being Able To Be Active
Not Being Able To Sleep Well
Avoiding Pills
Avoid Injections/Surgery
I Had Surgery and I'm Concerned About My Recovery
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What Is Your Main Goal You Would Like us to Help You Achieve?
Ease Pain
Ease Stiffness
Get Active
Stay Active
Avoid Dependency On Pills
Avoid Surgery
Find Out What's Wrong
Stay Healthy And Get Fixed BEFORE Pain Gets Worst
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