Phone Consultation
Name
*
First Name
Last Name
Primary Reason for Wanting to Speak with a Specialist
*
I'm in lots of pain and want some tips and advice I can start using straight away.
I would love to know what's wrong and how long it will take to ease.
I'm not sure if physical therapy is right for me and talking to a physical therapist first would help.
Where is your pain or stiffness?
*
Low Back
Shoulder/Neck
Knee
Hip/Thigh
Foot/Ankle
Headache
Muscle Strain
Post-natal Pain
What is concerning you the most?
*
The pain you are experiencing
Worry over not knowing what's wrong
Concern at no signs of improvement
Want to avoid painkillers
Fear of not being able to keep active
Future ill health (and preventing it)
Back
Next
How long have you suffered or worried?
*
Haven't (this is prevention, not a cure)
A few days
1-2 weeks
2-4 weeks
1-3 months
Long enough
Too long (years)
What is your main goal that you would like us to help you achieve?
*
Ease pain
Ease stiffness
Get active
Stay active
Avoid painkiller dependency
Find out what's wrong
Stay healthy and get fixed BEFORE pain gets worse
Back
Next
So that we can arrange this complimentary phone consultation, please tell us:
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Best time for a call back:
*
During the day
After 5 PM
Anytime
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