What is/are your diagnosis?

How long have you been experiencing pain *

Less than 1 Month

1-3 months

3-6 months

6-12 months

Over 1 year

How intense is your pain, from 0-5? *

What are you unable to do normally? What are your limitations?

Have you tried any previous treatment with any of the following specialist? (Check all that apply) *

Chiropractor Care

Physical Therapy

Occupational Therapy

Acupuncture

Pain Management

Orthopedist

Neurologist

None

Have you completed any of the following diagnostic test within the past year ? (Check all that apply)

X-ray

CT scan

MRI

EMG or Nerve Study

You have provided us with valuable information on how to assess your condition.

We appreciate you taking the time to complete this treatment finder assessment and look forward to providing you with the results you are searching for!

When is the best time for our team to reach you? *

9am-12pm

12pm-4pm

4pm-6pm

Full Name *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the NJ Sports Spine and Wellness.

Stay in the loop with free informational emails about exercise, stretches, new technology & machines, community events and so much more that NJ Sports Spine and Wellness offers by adding your email below!

We look forward to serving you!

Email *

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