Step 2: Fill Out The 60-Second Assessment Below To Secure Your Spot

Fill out your assessment. This will give us a great introduction to your situation, so we'll know how we can best help you.

Please Note: If you do not fill out the evaluation, we will not be able to secure your spot with this special offer for a $37 Decompression Consultation, Exam, Imaging Review, Report of Findings, X-Ray , 1st Treatment, and Treatment Recommendations. This is normally $349.

On a scale of 1-10, one being hardly any pain and ten being unbearable, how would you rate your pain?

1

2

3

4

5

6

7

8

9

10

How did the pain begin? Choose all options that apply.

Accident at home

Vehicle accident

Accident at work/work related

It just began

After surgery

Came on gradually

Sports related

Other

Have you had any surgeries to your existing pain or any other pain condition?

Yes

No

How committed are you to fixing your pain TODAY?

Very committed

Very committed
Somewhat committed
Neutral
Not ready to commit yet
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Scheduling Number: (561) 621-1311

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