So That We Can Serve Your SPECIFIC Needs, Please Fill Out This Form (it only takes 30 Seconds) And Tell Us EXACTLY How You Want Us To Help YOU… The more we know about you, the better we can help you.

PT, Gym, Personal Training
  • Physical Therapy
  • Gym Memberships
  • Personal Training
  • I'm not sure
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  • List is empty.
Where does it hurt?
  • Espalda / Back
  • Knee / Rodilla
  • Neck / Cuello
  • Foot/Ankle / Tobillo
  • Hip / Cadera
  • Pelvic Region
  • Shoulder / Hombro
  • Jaw / Mandíbula
  • Headache / Dolor de Cabeza
  • Injury From Sports/Exercise
  • Lesiones por deportes o ejercicio
  • Not Sure Where It's Coming From
  • No estoy seguro de dónde viene
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  • List is empty.
What Concerns You The Most That Makes You Want To Consider Physical Therapy?
  • The Pain You Are Experiencing
  • El Dolor Que Tiene
  • Not Knowing What's Wrong
  • Sin saber qué está mal
  • Want to Avoid Pain Killers & Medications
  • ¿Quiere evitar analgésicos y medicamentos?
  • Fear of Not Being Able to Stay Active
  • Miedo a no ser capaz de mantenerse activo
  • The Risk of Needing Dangerous Surgery
  • Concerns at No Sign of Improvement
  • El riesgo de necesitar una cirugía peligrosa
  • Preocupaciones ante ninguna señal de mejora
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How Long Have You Suffered or Worried?
  • Haven't - This is Prevention (Not Cure)
  • No lo he hecho - Esto es prevención (no cura)
  • A Few Days / Algunos Días
  • 1-2 Weeks / Semanas
  • 2-4 Weeks / Semanas
  • 1-3 Months / Meses
  • Long Enough (4+ Months) / Lo Suficientemente Largo
  • Seems Like Too Long (Years/ Años) / Parece Demasiado Tiempo
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Please Choose Your Ideal Day(s) For An Appointment
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
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Please Indicate Your Ideal Times
  • 6am
  • 7am
  • 8am
  • 9am
  • 10am
  • 11am
  • 12pm
  • 1pm
  • 2pm
  • 3pm
  • 4pm
  • 5pm
  • 6pm
  • 7pm
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