Please tell us...
Please Enter Your First Name
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How Many Falls Have You Had In The Past Year?
none
0-1
2-3
4
How Would You Describe Your Dizziness?
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Spinning
Lightheaded
Wobbly
Nausea
What Causes Your Dizziness?
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Please select one
Turning Your Head
Rolling In Bed
Driving
Standing Up
Not Sure Where It's Coming From
What Does It STOP You From Doing?
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Your Main Concern
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Please select one
Fear Of Falling
Dizziness
Worry about not knowing what's wrong
Want to avoid painkillers
Concern at no signs of improvement
Future ill health (and wanting to prevent it)
How Long Have You Suffered Or Worried?
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A Few Days
1-2 Weeks
2-4 Weeks
1-3 Months
Long Enough
Too Long (Years)
What do you value most when making your decision to choose a Physical Therapist? (check all that apply)
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Natural Treatments
Hands on care (example: massage, manual therapy, etc.)
One-on-one care
Home Exercises To Speed Up Your Recovery
The Main Goal You Would Like Us To Help Achieve For You
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Please select one
Ease dizziness
Improve balance
Stay active
Avoid medication dependency
Find out what's wrong
Stay healthy and get better before pain worsens
So we can rush the cost and availability of the service you have requested, please lease us:
Best Phone Number
*
Best E-mail
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Click To Submit Your Inquiry >>
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