First Name *

Last Name *

Email *

Phone *

What do you know about Shockwave Therapy? *

I know what it is and how it works

I have heard about it's benefits but couldn't explain them

I have no idea what it is, how it works or what it's used for

How long have you been in pain? *

I have no pain

Less than 4 weeks

Between 4-12 weeks

More than 12 weeks

Do you have a clinical diagnosis for your pain? *

Yes (confirmed by a medical professional)

No

Do you have imaging that confirms the diagnosis? *

Yes (ultrasound or MRI)

Other (CT or Xray)

No

Where is your pain located? *

Achilles Tendon (back of the ankle)

Plantar fascia (heel or base of foot)

Patella/Quads Tendon (just above or below the kneecap)

Hamstring Tendon (on you sitting bone)

Gluteal Tendon (outer hip area)

Elbow (tennis or golfers elbow)

Shoulder

Other Area

How would you best describe your pain? *

Stiff and achy, especially in the mornings

Sharp during or after activity

Constant dull ache

Comes and goes unpredictably

Burning or tingling sensation

What treatments have you tried so far? *

Exercise and rehabilitation

Manual therapy or dry needling/acupuncture

Load-management and activity modification

Painkillers or anti-inflammatories

Steroid or other injections

Rest

Tick all that apply

How is the pain affecting your daily life? *

Barely noticeable

Manageable but limiting the things I do

Significantly limiting what I can do

I've had to stop all activities and hobbies

What best describes your outlook on the use of shockwave therapy for your injury? *

I want to use it alongside exercise as a comprehensive treatment plan

I prefer to use it alongside passive treatments such as massage

I am willing to try anything to get better as long as its little effort

I don't know what it is or how it works but I am desperate for some pain relief

Do you have any of the following: *

Active cancer

Blood clotting disorders or vascular conditions

Pacemaker or implanted device

Local infection or open wounds near treatment site

Recent steroid injection near the treatment site

Currently pregnant

Under 18 years of age

None of the above

Tick all that apply