Please tell us...
First Name
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First Name
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Last Name
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Which Service Do You Need?
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Physical Therapy Evaluation and Hands On treatment
Dry Needling
IASTM (Instrument assisted soft tissue mobilization)
Prehab (Pre-surgical rehab)
The Main Goal You Would Like Us To Help You Achieve.
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Please select one
Ease pain
Ease stiffness
Stay active or involved in sporting activity
Avoid painkiller dependency
Find out what's wrong
Stay healthy and get better before pain worsens
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Where Does It Hurt?
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Please select one
Back
Knee
Shoulder/Neck
Sports or Exercise Injury
Foot/Ankle
Wrist/Hand
Elbow
Not Sure Where It's Coming From
Infusionsoft Tags
What Does It STOP You From Doing?
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Your Main Concern
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Please select one
The pain you are experiencing
Fear of not being able to keep active/involved in sporting activity
Worry about not knowing what's wrong
Want to avoid painkillers
Concern at no signs of improvement
Future ill health (and wanting to prevent it)
How Long Have You Suffered Or Worried?
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A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Too Long (Years)
What do you value most when making your decision to choose a Physical Therapist? (check all that apply)
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One-on-one care
Hands on care (example: massage, manual therapy, etc.)
Home Exercises To Speed Up Your Recovery
Convenience
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So we can quickly provide you the cost and availability of the service you have requested, please provide us:
Best Phone Number
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Best E-mail
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Please verify that you are human
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