Take this 30-second quiz to see if you qualify for a
FREE
Pain Relief Session.
How long have you been experiencing pain?
*
Just Recently
0-6 Months
6-12 Months
More Than 12 Months
Where are you experiencing pain?
*
Neck Pain
Back Pain
Shoulder Pain
Knee Pain
Foot Pain
Hip Pain
Other
What is this pain preventing you from doing?
*
Walking
Running
Sleeping
Exercising
Family Time
Other
What have you tried in the past to get relief?
*
Medication
Physical Therapy
Chiropractic
Physician
Googled It
Others
How old are you?
*
18-24
25-34
35-44
45-54
55-64
65 & older
What type of insurance do you have?
*
Medicare
Medicaid
Humana
Blue Cross Blue Shield
United Health Care
Freedom
WellCare
Ambetter
CareLink
Preferred Care
Health first
GEHA
Golden Rule (UHC)
Careplus
Bright Health
Oscar
Sunshine Health Ambetter
Other
Other Insurance?
*
Aetna
Sunshine Health Medicare
Cigna
Multiplan
Tricare
Wellmed Workman's Comp
Healthsmart
National Employee Benefits
UMR
Optimum
Freedom Health
Champ VA
UHC Dual
Self Insured Plan
None of the above
No Insurance
Are you willing & able to invest in your health & wellness?
*
Yes
No
Our staff has reserved their time for people who are serious about improving their health and wellness. Will you be able to commit to this appointment after confirming the day and time with our front desk?
*
Yes
No
What's your full name?
*
What's your email?
*
What's your phone number?
*
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