READY TO START YOUR JOURNEY OF RECOVERY?

Name *

First Name

Last Name

What are you having trouble with? *

Back Pain

Sciatica

Both

How long has it been bothering you? *

Less Than A Week

1-4 weeks

1-2 months

3-6 months

7-12 months

More Than A Year

What is your main concern? *

The pain I'm having

It's not getter better / its getting worse

Avoiding painkillers and/or surgery

Losing my mobility and independence

I cannot do the things I need or want to do

What do you value most when making your decision to chose a health care provider? *

Someone who will listen to me

Someone who will provide a thorough explanation of my problem

Hands-on care

One-on-one care

To learn things you can do at home to speed up your recovery

Something else...