First Name
*
Last Name
*
Email
*
example@example.com
What is your MAIN concern or problem area?
*
Please Select
Back Pain
Neck / Shoulder Pain
Hip / Knee Pain
Elbow / Wrist Pain
Dizziness / Vertigo
Balance Problems
General Weakness
Something Else
How long has this been going on?
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Please Select
It just happened – only a few days
A few weeks
A few months
One year or more
Not really a problem – looking for prevention
How is this problem impacting your life?
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Please Select
I can’t do certain things I want to do
I'm avoiding things or not pushing myself because
I’m doing everything – it just hurts and it’s annoying
It’s not impacting my life yet – but I’m worried it might
I’m not sure – I just want to talk to an expert
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What is the MAIN reason you’re interested in a Discovery Session?
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I’ve never tried Physical Therapy and I’m not sure what to expect
I was let down by another Physical Therapist in the past and want to make sure you’re a good fit
I’m not really sure Physical Therapy can even help me
I’d like to get a feel for what you can do to help me before I choose to work with you
I want to avoid pain pills or surgery to fix my problem
What kind of format for the Discovery Session do you prefer?
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Please Select
In Person at the NFT Clinic (North Austin)
Phone Call
Virtual Meeting (Zoom)
How did you hear about us?
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Please Select
Friend or Family member
Facebook
Google
Flyer/Event
Newspaper
Other
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Phone Number
*
By providing your phone number, you agree to receive SMS/MMS messages from Natural Fit Therapy
When is the best time to call you?
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Please Select
Morning before 10AM
10AM – 1 PM
1PM – 5PM
After 5PM
Anytime!
Anything else you want to add or really want us to know?
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