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Yoga Therapy - Appointment Request
We provide you with yoga, meditation and mindfulness as a part of our holistic, integrated and comprehensive pain management program
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
Your answer
Best phone number (mobile phone preferred)
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Your answer
YOGA options (click all that apply)
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Yoga Therapy
Yoga Classes (for Active mobile Adults who can get up and down off floor with ease)
Gentle Yoga Class (for People who have restrictions due to pain, injury or lack strength)
Chair Yoga (for people who cannot work out on the floor)
Chronic pain and metal health conditions? (click all that apply)
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Chronic spinal painful condition
Chronic upper extremity painful condition
Chronic lower extremity painful condition
Chronic mental health condition-Depression, PTSD etc.,
Chronic painful malignant condition like Cancer
Required
Can you attend an appointment at:
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Dover (240 Beiser Blvd) office -open all five days a week
Other:
Required
Can you afford to pay for our service if it is not covered by your insurance ($1 per minute)
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Yes
No
Other:
If suffering from chronic, are you interested in a pain management consult with our providers you can fill up new patient appointment form on our website: www.painrehab.net
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Yes
No
We offer various holistic therapies that require you to pay for these services
Acupuncture ($1 per minute)
Yoga Therapy ($1 per minute)
Cupping Therapy ($1 per minute)
One on one therapy - stretching, strengthening, taping, exercise etc., ($1 per minute)
Massage Therapy with CBD oil ($1 per minute)
CBD products like gels, creams, tinctures and ointments ($30)
Vitamin IV Infusions - for health and wellness ($250)
Plasma Rich Protein Injection - for natural pain relief ($500)
Stem Cell Injection- for natural pain relief ($3000)
Other:
Thank you! We will confirm your appointment in 3-5 days.
For additional practice information:
www.painrehab.net
For new patient appointment:
https://forms.gle/Bg1L53DWFbQVWvMLA
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