Pain & Rehab Consultation
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Email address
*
Your email
Name
*
Your answer
Are you interested in:
*
A Consultation
A Consultation & Programming
Unsure
Do you need a consultation for post-operative care?
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Yes
No
Please provide background about yourself and any current issue(s) you’ve been dealing with.
How old are you?
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Your answer
What is your profession?
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Your answer
What seems to be the issue?
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Your answer
Where are you experiencing symptoms?
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Neck Pain
Mid Back Pain
Low Back Pain
Knee Pain
Elbow Pain
Wrist/Hand Pain
Foot/Ankle Pain
Hip/Groin Pain
Shoulder Pain
Other
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Do you have any pre-existing conditions we should be aware of?
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Your answer
Currently taking any medications? Over the counter supplements?
*
Your answer
Has this issue occurred previously?
*
Your answer
What have you done for this issue previously and/or currently?
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Your answer
If you've been evaluated for this by another professional, what have you been told about it?
Your answer
Do you currently exercise? If so, what has your recent (3-6 weeks) training regime consisted of? Please be as detailed as possible (include details such as number of training days, exercises, sets, reps, load, recovery days/methods, etc.).
*
Your answer
What type of workout equipment and/or facilities do you have regular access to?
*
Your answer
What are your expectations from working with us?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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