First Name

Last Name

Phone *

Email *

Where are you located? *

South Shore Long Island — I can make it to Oakdale

I'm farther out — travel would be a stretch

I'm outside of Suffolk County entirely

Tell us what's been happening with your body. What brings you here? *

How long have you been dealing with this? *

A few weeks — it's pretty new

Several months

Over a year — this has been my normal for a while

What have you already tried? (check everything that applies)

Phase 1 of the Framework requires 2 visits per week for 12 weeks. We currently see clients on Tuesdays, Thursdays, and Sundays. Can you show up for that? *

Yes — my schedule can support that

It would be tight but I'd make it work

Honestly, 2x a week is too much for my life right now

Is there anything going on in your life right now that might make it hard to prioritize your care over the next 6 months?

We are a cash-based practice. We don't bill insurance directly — your care is never dictated by what a plan will or won't cover. We provide superbills for out-of-network reimbursement and accept HSA/FSA, CareCredit (approval not guaranteed), and flexible payment plans. With that context — how does that land for you? *

I understand and I'm ready — cash pay works for me

I'd like to use HSA/FSA and pay cash for any remaining balance

I'd like to apply for CareCredit financing — I understand approval isn't guaranteed

I'd need a payment plan — I want to discuss options at my consultation

I need insurance to cover this — cash pay isn't an option for me right now

The Framework is a 6-month structured program, with flexible payment options discussed at your consultation. Knowing that — are you in a place where investing in your health at this level feels possible? *

Yes — I see the value and I'm ready to invest in my health

I want to know more about payment options before deciding

It's a stretch — but I'm committed enough to figure it out

Honestly, this isn't financially feasible for me right now

Why Sound Chiropractic? What made you choose us specifically? *

Is there anything else you want us to know before we review your application?

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