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FixYourOwnBack One-on-One Coaching Program Application
1. Our One-on-One Coaching Program has a limit of 25 people every 6 months to allow us to provide excellent, personalized instruction. Please fill out this questionnaire to help us determine if this is a good option for you. We will determine if we currently are able to add you to our coaching program. If we are currently full, we can offer advice on other options or provide you with an idea about when our next availability might be.

2. If you previously filled out the intake form on FixYourOwnBack, thank you. That form will help track your progress as you go through any of our programs. This form will help us determine which of our programs will be the best fit for your current condition. We understand that questionnaire fatigue is real, but your responses help us learn enough to best match you to our programs.

3. Following the completion of this application, please email Dr. Snell directly at drsnell@drphillipsnell.com informing him that you have completed the application.

4. Your application will be reviewed and you will be informed if you are accepted into the program. If you do not receive an email response within 48 hours, please check your SPAM.  

5. If you are not accepted into the program, Dr. Snell will be more than happy to help you find the resources that will best fit your needs. Our goal is to help you solve your back pain problem and get your life back. If our programs are not the best fit, we'll try to help you find a better solution.

6. Your time is valuable, as is Dr. Snell's and his team's so please be accurate and thorough in your answers so that he can hopefully align you towards creating the best possible results for you so you can get back to  being the person you were before your back injury occurred.
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First and Last Name *
Age *
Email *
City of Residence *
State/Province of Residence *
Country of Residence *
How many months have you been suffering with back pain? *
Required
Give a brief description of the first time you felt pain in your back. What were the circumstances? *
Which of the following have you tried to help with your back pain? *
Required
Have you had MRI of your low back? *
Have you had surgery on your low back? *
How much money in USD would you estimate you've spent so far trying to heal your back pain? *
Required
Why do you think your results have not been effective? *
If you woke up tomorrow without any low back pain, what is 1 thing different you would do? *
Do you have pain bending forward to touch toes? *
Do you have pain bending backwards? *
Do you currently or have you previously experienced sciatica (pain/numbness/tingling into your buttock, leg or foot)? *
Is lifting painful? *
Is your back pain commonly worse in the morning, feels painful for an hour or so, then is better until the end of the day? *
If back pain was not a limiting factor in your life, what activities would you most like to do that you currently cannot do? *
We receive many applications and some applicants are more motivated than others. Are you a committed, highly motivated individual that is seriously ready to commit to a plan and will value the impact that a program and guidance from a low back expert can have on your life? *
The FixYourOwnBack Personal Coaching Program is a 6 month commitment to achieve a bullet-proof low back. Some individuals struggle with staying on task. Is this a duration you can handle? *
If you were accepted into the program, would you need to talk over the financial investment with anyone else in your life before making the decision? If so, who? *
The average spinal injection is $2000-$4000 USD out of pocket. If you had the option of spending $2000 for something that gives you a 30 second appointment with the provider and has a small chance of working with a very high recurrence, or spending $5000 (this is not the price of the program, purely an example) on something that provides months with an expert with a total understanding of your low back, strength, mobility, and a plan to keep it better that has a much higher chance of working, which would you choose? *
The average low back surgery is $20,000 USD and can include negative side effects and sub-par results, if you were given the option right now to avoid surgery and have better results for $5000, would that be worth it to you? (This is not the price of the FixYourOwnBack Personal Coaching program!) *
If "Yes", would you be able to make that $5000 USD investment now? *
Required
If "No", how long would you need to plan and budget to make that $5000 investment? *
Required
What would you ideally need from Dr. Snell's team if you were accepted to work with them 1-on-1 to achieve your goals without low back pain? *
Dr. Snell cares about your recovery! He has found that human nature has a tendency to overshadow the primary focus of gaining health and livelihood back with feeling unworthy of the cost. For that reason, our program costs will not be discussed until AFTER you experience encouraging results during the assessment process. If your application is  accepted, the next step will be a 15-30 minute interview via video chat to determine whether you would be a good fit for the FixYourOwnBack Personal Coaching Program. There is a small fee for the assessment time depending on the amount of time we spend in that conversation. *
Have you tried online rehab or virtual coaching before? *
Our self-guided online programs require your computer to be able to stream video content. The self-guided online programs require that you hold yourself accountable to consistently apply yourself daily for weeks to months? Pain relief will likely occur very quickly, but the full healing of the back pain requires longer effort. How motivated are you to put in that work without the need for someone else to hold you accountable? *
After you submit your application, we will review it, and then contact you for a brief virtual online meeting via Zoom or other video conferencing platform to discuss our decision. Please know that we have a limit on the number of people we can accept into the program every 6 months. Once we are full you may need to wait 6 months for the next opportunity to apply. Would you be able to make time (approx 15 minutes) to have that conversation? *
Required
Is there anything else Dr. Snell should know before the post-application video chat if you are accepted? *
How did you hear about FixYourOwnBack? *
Required
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