Please tell us...
Please Enter Your First Name
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Please Enter Your Kid's Name (if requesting on behalf of a child)
Which Service Do You Need?
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Physical Therapy
Other
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How Much Attention Do You Prefer?
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Please select one
30 Minutes (Silver)
60 Minutes (Gold)
Where Does It Hurt?
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Please select one
Back
Knee
Shoulder/Neck
Sports or Exercise Injury
Foot/Ankle
Wrist/Hand
Elbow
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
The pain you are experiencing
Fear of not being able to keep active/involved in sporting activity
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 pain
Ease stiffness
Stay active or involved in sporting activity
Avoid painkiller dependency
Find out what's wrong
Stay healthy and get better before pain worsens
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So we can rush the cost and availability of the service you have requested, please lease us:
Best Phone Number
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Best E-mail
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Which Clinic location is closer?
Pagadian
Ipil Sibugay
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