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Name*
What Area/Body Part Are You Looking For Help With? Click for Choices Back Lower Back Knee Leg Neck/Shoulder Foot/Ankle Hip Pelvic Region Arm/Wrist/Elbow Head/Jaw Headaches/Migraines Muscle Injury From Sport/Exercise Not Sure Where It's Coming From
If Other Please Describe Here (optional)
What Concerns You The Most That Makes You Want To Consider Physical Therapy?* Click for Choices The pain you are experiencing Not Knowing What's Wrong Want to Avoid pain killers & medications Fear of not being able to stay active The risk of needing dangerous surgery Concern at no sign of improvement
How Long Have You Suffered or Worried? Click for Choices Haven't - This is prevention (not cure) A few days 1-2 weeks 2-4 weeks 1-3 months Long enough (4+ months) Seems like too long (years)
Main Goal Of Using Our Specialist Service Click for Choices Ease Pain Ease Stiffness Get Active Stay Active Avoid Painkiller Dependency Find Out What's Wrong Stay Healthy and get fixed BEFORE pain gets worse
Best Time For A Call Back Click for Choices Between 6am and 8am During the Day After 5pm Anytime
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