Fill out this survey completely, accompanied by a photo of your face, and receive a $15 account credit to be used toward any purchase. Include a photo and get an extra $5! Thank you so much - your story helps someone find the help they need.

First Name *

Last Name *

Date of birth *

Email *

Phone *

How did you hear about LUMEN?

How would you like us to use your testimonial? *

Age, First Name, Last Initial & Photo ($20 credit)

Age, First Name & Last Initial Only ($15 credit)

Age, First Name Only ($15 credit)

Age, Anonymous ($15 credit)

Please describe your biggest challenge or concern that you wanted to improve by coming to LUMEN. What kind of limitations did that put on your daily life?

What had you tried before, and why didn't it work for you?

How many sessions did you do to address the particular problem that you're sharing with us?

What service(s) did you decide to try at LUMEN and why?

How was your experience during your care at LUMEN? Did anything stand out to you?

How quickly did you begin noticing improvement?

What surprised you about the process or the results?

What changes have you noticed since starting your care at LUMEN?

Were you being treated by any medical professionals for this challenge? Tell us any feedback, assessments or scans you've received to track your progress.

If yes, please let us know who your provider is!

Has anyone else noticed a difference in you? What have they said?

Anything you wish you had known at the beginning of your journey that you want someone considering LUMEN to know?

Do you have any additional comments or suggestions to help us improve our services?

Please upload a photo of your face to accompany your story. (This is required for the extra $5 credit.)

If you have any before or after photos you'd like to share, please upload them below. Thank you!

Before Photo (ie. immediately after injury, rehab, surgery, etc)

After Photo (ie. running, fully healed, etc...)

Would you be willing to participate in a video testimonial telling your story?

Please indicate yes or no

By checking the box and submitting my testimonial and images, I confirm that I have read, understood, and agreed to these Terms & Conditions.