top of page
Answer the following questions:
Are you in pain today?
At the present time, how would you rate your overall health?
Have you had any of the following tests related to this condition: (if yes, check all that apply)
Do you have a pacemaker/defibrillator?
Do you have any allergies?
Do you smoke cigarettes?
Are you pregnant or think you could be pregnant?
Have you experienced any falls in the past 12 months?
Do you take any medications?
Have you recently experienced any of the following? Check off those you have.
Have you ever been diagnosed with any of the following conditions?

We'll get in touch with you soon!

bottom of page