First Name
*
Last Name
*
Primary Reason For Wanting a Discovery Visit
*
I Want to Learn More About Your Treatment Approach
Other Treatments Haven’t Helped My Pain & I’m Looking for a Better Option
I’d Like to Understand Your Approach Before Committing
I'm Unsure If Non-Surgical Treatment Is Right for My Condition
I’d Like to Discuss My Condition & See If This Is Right for Me
I’d Rather Talk First Before Scheduling Anything
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Where Does It Hurt?
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Neck
Shoulder
Back
Hip
Knee
Ankle/Foot
Elbow
Wrist
Hand
Injury From Sport/Exercise
Headaches/Migraines
Not Sure Where It’s Coming From
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What Does It Stop You From Doing?
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What Concerns You Most
Not Knowing What's Wrong
Dependency Upon Painkillers
Fear Of Losing Mobility Or Independence
Risk Of Facing Dangerous Surgery and/or Injections
Other Concern (Not Listed)
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How Long Have You Suffered or Worried?
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Haven’t - Looking For Prevention
A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Too Long (Years)
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What Is Your Main Goal?
*
Ease Pain
Ease Stiffness/Tightness
Get Active
Stay Active
Avoid Painkillers/Injections/Surgery
Find Out What's Wrong
Stay Healthy & Get Fixed BEFORE Pain Gets Worse
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Phone
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Email
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