Rate the severity of the pain in your hands/feet (1 = hardly any, 5 = excruciating) *

What neuropathy symptoms are you experiencing? Choose all that apply. *

Numbness

Tingling or Burning

Sharp Pains or Cramps

Muscle Weakness

Extreme Sensitivity to Touch

Serious foot problems, such as ulcers, infections, and bone and joint damage

Other

What areas of your life are being affected by your neuropathy? Choose all that apply. *

Walking

Work Ability/Productivity

Enjoying Hobbies

Sleep

Household Chores

Playing with My Kids or Grandkids

Ability to Relax and Recharge

Mental/Emotional Well-being

If any, what neuropathy treatments have you already tried? Check all that apply. *

Medications/Painkillers

Physical Therapy

Acupuncture

Lifestyle Changes/Home Remedies

Surgery

Injections

Cold Laser Therapy

None

Other

Okay! Just a few more questions: Are you aware that this offer is not covered by either Medicaid or Private Insurance? *

Yes, I agree and understand this offer is not covered by insurance

No, I am only interested in insurance-covered services

Do you happen to have any Advanced Imaging such as an MRI and/or X-Rays to bring to your appointment? *

Yes

I am aware that the clinic is situated at 1490 Alamo Dr # B, Vacaville, CA 95687, and I am both willing and able to commute to this location. *

Yes

Thanks! For a limited time, we're offering a Full Neuropathy Consultation & Treatment for $77 (Usually $497)! Fill out your information below to claim offer:

Full Name *

Phone *

Email *

I agree to the terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.