We'll get you feeling better as soon as possible
(1) Kindly complete the questions to follow to better help us understand your pain symptoms. (2) We will review your Urgent Request for Treatment and get back to you as soon as possible. (3) Our Urgent Care days are Wednesdays & Thursdays weekly (4) We will be scheduling appointments in order of priority sequence based on level of urgency (we will book you in any day of the week where we have an available appointment, but Wednesdays & Thursdays are the days we aim to fill up with Urgent Care).
Would this be your initial visit?
*Please Note: Temporarily we will not be taking New Patients as we attempt to clear our Waiting List. Once we catch up on assisting patients we will remove this note --> Continue to check back for this update to be removed.
(You are still welcome to let us know your current pain symptoms and situation and we will email you that we have received it. We just may not be able to help you as quickly as you would hope, and encourage you to continue to look for a clinic that can help you sooner) We will also contact you to advise of a few options for you.
What is your name?
What are you have problems with?
Referred pain /Nerve pain
What is the location of your pain?
What are your pain symptoms?
What is your pain intensity (right now)?
1 is Best, 10 is Worst
When did your pain start? (approximately)
Are you currently doing any other types of Treatment for this concern?
Tell us the best way to reach you.
Preferred method of contact?
What is the best time of day to reach you?
Lastly, please indicate which days/times are best suitable for your schedule to come in for Treatment:
Should be Empty:
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