Pain & Rehab Consultation
Email address *
Name *
Are you interested in: *
Do you need a consultation for post-operative care? *
Please provide background about yourself and any current issue(s) you’ve been dealing with.
How old are you? *
What is your profession? *
What seems to be the issue? *
Where are you experiencing symptoms? *
Required
Do you have any pre-existing conditions we should be aware of? *
Currently taking any medications? Over the counter supplements? *
Has this issue occurred previously? *
What have you done for this issue previously and/or currently? *
If you've been evaluated for this by another professional, what have you been told about it?
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.). *
What type of workout equipment and/or facilities do you have regular access to? *
What are your expectations from working with us? *
A copy of your responses will be emailed to the address you provided.
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