Free 15 minute phone consultation.

Please fill out the following form
in order to receive your free consultation.

Full Name

Email

Have you had any operations in the past 6 weeks? *

No

Yes

Phone

Possibly pregnant? *

No

Yes

Present or ongoing health conditions, if so what?

Past major operations? *

No

Yes

Main reason for requesting treatment *

Maintenance

Pain Relief

Any specific areas involved? *

Back

Knees

Shoulder/s

Arms

Hands or Feet

Other

Please specify or add notes

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