Please tell us...
Please Enter Your First Name
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Please Enter Your Kid's Name (if requesting on behalf of a child)
Which Service Do You Need?
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Physical Therapy
Sports Performance & Recovery
Consulting & Seminars (For Coaches and Healthcare providers)
Professional Mentorship
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What is your main problem?
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Please select one
Pain in a joint or other body tissue
Urinary leakage
Leakage of stool
Painful intercourse or penetration
Painful periods
Diastasis Recti
Surgery Related (ex: hysterectomy, c-section, hernia)
I'm not sure
What Does It STOP You From Doing?
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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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Natural Treatments
Hands on care (example: massage, manual therapy, etc.)
One-on-one care
Home Exercises To Speed Up Your Recovery
The Main Goal You Would Like Us To Help Achieve For You
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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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So we can rush the cost and availability of the service you have requested, please leave us:
Best Phone Number
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Best E-mail
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