Take this 30-second quiz to see if you qualify for a
$27
Pain Relief Session.
How long have you been experiencing pain?
*
Just Recently
0-6 Months
6-12 Months
More Than 12 Months
Where are you experiencing pain?
*
Neck Pain
Back Pain
Shoulder Pain
Knee Pain
Foot Pain
Hip Pain
Other
What is this pain preventing you from doing?
*
Walking
Running
Sleeping
Exercising
Family Time
Other
What have you tried in the past to get relief?
*
Medication
Physical Therapy
Chiropractic
Physician
Googled It
Others
How old are you?
*
18-24
25-34
35-44
45-54
55-64
65 & older
What type of insurance do you have?
*
Medicare
Medicaid
BCBS
Aetna
UHC
CIGNA
Tricare
No Insurance
None of the Above
Are you willing & able to invest in your health & wellness?
*
Yes
No
Our staff has reserved their time for people who are serious about improving their health and wellness. Will you be able to commit to this appointment after confirming the day and time with our front desk?
*
Yes
No
What's your full name?
*
What's your email?
*
What's your phone number?
*
