Service Inquiry Form- 15-Minute FREE Call with Brian Carroll
Still not sure which service is right for you? Fill out this form to let Brian know when you are available for a call to help choose the service best for your back pain condition, injury resilience, and/or performance enhancement.

🔴 This form is for FIRST TIME Clients who have not yet seen Brian. If you are looking to book a Follow-Up call please book your call with this link: https://www.powerrackstrength.com/consult-brian-carroll/

You will receive an email response within 24hrs of submitting your form. Please look out for emails from Brian and or his assistant Bristol for updates and scheduling of your call.

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Email *
Please answer all of the following questions:
Name *
Phone Number *
Address
* State and Country
 *
Age *
Occupation *

What is your specific injury or diagnosis (if known)?

 *

How long have you been dealing with it?

 *
Have you had an MRI? *
Required
If yes, do you have a physical copy?  *
Required

Have you had a back-related surgery before? If so, what kind and date of operation?

 *
Have you seen a McGill-certified clinician before? if so, who? and when *
What are you goals with working with Brian?  *
Are you willing to travel to Jacksonville, FL for In-Person assessment?  *
Required
Have you read Back Mechanic?  *
Required
Have you read Gift Of Injury?  *
Required
Please share how you heard of me and what made you book with me. *
Required
What time of day will you be available? 
Brian is located in Eastern Time Zone (EST)

❗️This is NOT scheduling you a call, this is to determine the time frame in which your call may take place. You will be contacted via email to schedule your call.❗️
 *
Required
Call Type
It is important for this to be a video call, please select which video call type you are able to make.
 *
Required
Message
(Any additional information or comments you would like to share) 
Please make sure you have entered in all of your information correctly. (Phone number, email, address, etc.) *
Required
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