What's your gender?
*
Male
Female
First Name
*
Where's the problem?
Head/Neck
Shoulder
Back
Pelvic Floor
Hip
Knee
Foot/Ankle
Elbow
Wrist/Hand
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What does it stop you from doing?
*
What's your main concern?
*
Not knowing what's wrong.
Depending on medication.
Risk facing surgery.
Losing mobility/independence.
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How long have you suffered or worried?
*
A few days.
1-2 weeks
2-4 weeks.
1-3 months.
Long enough.
Seems like too long (years).
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What is your main goal right now?
Get out of pain
Avoid injections or surgery
Get back to activity/sport
Understand what’s really going on
All of the above
How committed are you to solving this problem?
Extremely committed — I need this fixed
Very committed — I’m ready to take action
Moderately committed — I’m exploring options
Slightly committed — just starting to look
Just gathering information
Phone
*
Email
*
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