First Name
Pick your ideal day for an appointment
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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Indicate Ideal Time (We're Open 9am - 8pm)
8am
8:30am
9am
9:30am
10am
10:30am
11am
11:30am
12pm
12:30pm
1pm
1:30pm
2pm
2:30pm
3pm
3:30pm
4pm
4:30pm
5pm
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How Much Time & Attention do You Prefer
30 Minuets (Bronze)
45 Minuets (Silver)
60 Minuets (Gold)
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Which Services Do you Require
Physiotherapy
Acupuncture
Sports Massage
Podiatry
Injection Therapy
How Long Have You Suffered Or Worried?
Haven't - this is prevention not cure
Unknown
A few days
1-2 weeks
2-4 weeks
1-3 months
3-6 months
6-12 months
Approx 1 year
Seems like too long (2+ years)
Ongoing problem
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Where Does It Hurt?
Lower Back
Back
Elbow
Knee
Leg / Calf / Thigh
Shoulder / Neck
Foot /Ankle
Rib / Chest
Wrist
Finger / Thumb
Muscle Injury From Sports / Exercise
Postnatal Back Pain
Headaches / Migraines
Hip
Arm
Sciatic Pain
No Particle Area
Not Sure Where It's Coming From
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What Concerns You The Most?
Not knowing What's Wrong
Depending Upon Painkillers
Losing Mobility & Independence
The Risk Of Facing dangerous Surgery
Other Reasons
No Concerns
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What does it stop you from doing?
Email
*
Phone
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