Back Pain Questionnaire
Fill this out get a $4 coupon code at the end.
Email address *
What is causing your pain? (Select all the apply) *
Required
How long have you been having this pain? *
What have you tried to remedy your pain? (Select all the apply) *
Required
On a scale of 0-10 what is your pain level? (0 being no pain and 10 being severe debilitating pain) *
Have you had any of these tests? (Select all the apply) *
Required
Which therapy would you be more inclined to purchase? *
What would be your reason for not purchasing a product that you see online that would guarantee results? *
If a therapy is uncomfortable but you feel better afterword would you continue the therapy? *
Have you ever heard of spinal decompression therapy before? *
Compression, like gravity squeezes your spine and compresses your discs, nerves and joints, do you think that compression could be causing your pain? *
If your medical doctor told you that a therapy would not help you, even though you know it will, would you continue with the therapy or would you listen to your doctor and stop the therapy? *
What condition are you tying to fix? (Check all that apply) *
Required
If someone guaranteed you would feel better with a therapy that cost $100 would you purchase it or would you continue to do more research? *
Which way do your prefer to order? *
A copy of your responses will be emailed to the address you provided.
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